memory care director- lvn

picu nurse practitioner

utilization review nurse

IMCS Group

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 Job Title: Clinical Review Nurse &ndash; Prior Authorization
 
 
 Duration: 3 months Contract (Potential to extend)
 
 
 Location: Fully Remote, TX, central time zone preferred
 
 
 Shift Type: Monday-Friday 10 AM-7PM CST- 1 hour lunch , Training &ndash; 4-5 weeks 8AM &ndash; 5PM CST (No days off) CAMERA ON
 
 
 
 
 
 Job Duties:
 
 
 &bull; Day to day will include performing clinical reviews for prior authorization requests utilizing policies, Interqual, sending to the MD if needed. Additionally, will assist with out of network requests and redirecting to in network providers as needed.
 
 
 &bull; Performance expectations will include completing at least 20 clinical reviews per day and if assisting with out of network requests will perform 2 redirections per hour
 
 
 &bull; This role is unique as it supports Marketplace expansion for Texas. Team currently consists of 21 prior authorization nurses performing this work, it is a team effort, collaboration with team members is available to answer any questions and training will be handled at the team level.
 
 
 
 
 
 Years of experience required:
 
 
 &bull; 2&ndash;4 years of experience required in a related field.
 
 
 &bull; Adaptable to change
 
 
 &bull; Quick processing, critical thinking
 
 
 &bull; Well organized
 
 
 
 
 
 Additional qualities to look for:
 
 
 True care experience
 
 
 
 
 
 Education/Certification Required:
 
 
 ADN, BSN - Requires Graduate from an Accredited School of Nursing or bachelor&rsquo;s degree in nursing and 2 &ndash; 4 years of related experience.
 
 
 
 
 
 Licensure Required:
 
 
 Must have compact state licensure an/or Texas licensure.
 
 
 
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Utilization Review Nurse

NEHCR Staffing LLC

Board certified Family and Adult Nurse Practitioners 1099 needed to perform Compensation and Pension Examinations on Veterans, to assistin their VA Benefits Claims. Great Supplemental Income Opportunity. $400 - $800+ / day Flexible Part Time Opportunity Must own and operate own ADA/OSHA compliant practice Two years+ NP Experience (some prior VA work is ideal). NP mustbe computer savvy and be able to work on their own personal laptop. NPshould have either experience with, or take it upon themselves to becomefamiliar with a goniometer (expect to use daily while performing exams,instrument provided) <ul> <li> Earn additional income with direct payments twice monthly </li> <li> Maintain complete control over your schedule and availability </li> <li> Deal with minimal administrative work </li> <li> Serve veterans while potentially acquiring new patients </li></ul> Role: Complete a thorough review of digital medical records,conduct a physical assessment based of specific disability claims, and submitinformation gathered though an online portal for the VA to review as part of acompensation/pension claim. All exams will take place at approvedfacility with proper equipment and internet access provided. Collaborative Physician, General Liability, ProfessionalLiability covered by company

Family Practice/Primary Care Nurse Practitioner

eviCore healthcare

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States. Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated. Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions. Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications. Participates in strategic planning for and evaluation of the Care Management The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Maternal - Fetal Medicine, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months). Must have a minimum of 5 years clinical experience, beyond residency/fellowship Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is required No nights, no weekends, not call. Predictable work schedule Full and part time opportunities Salaried position with benefits Supportive organization with collaborative culture eviCore healthcare is committed to making a positive impact on healthcare, and also making a positive impact on our employees. eviCore offers a variety of perks and benefits including, but not limited to: Flexible scheduling and work/life balance with remote and work from home opportunities 4 weeks of PTO(starting) per year plus paid holidays One week of CME Education assistance, tuition reimbursement and professional certifications Health, dental, vision, and life benefits with employer funded HSA Paid Volunteer Community Service Days Ample opportunities for growth, advancement, and promotion 401k retirement plan with company match of 50% employee contributions up to 6% eviCore is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation

Physician / Other / Texas / Permanent / Associate Medical Director - Maternal Fetal - 100% Remote Job Job

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States. Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated. Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions. Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications. Participates in strategic planning for and evaluation of the Care Management The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Cardiology, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months). Must have a minimum of 5 years clinical experience, beyond residency/fellowship Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is required No nights, no weekends, not call. Predictable work schedule Full and part time opportunities Salaried position with benefits Supportive organization with collaborative culture eviCore healthcare is committed to making a positive impact on healthcare, and also making a positive impact on our employees. eviCore offers a variety of perks and benefits including, but not limited to: Flexible scheduling and work/life balance with remote and work from home opportunities 4 weeks of PTO(starting) per year plus paid holidays One week of CME Education assistance, tuition reimbursement and professional certifications Health, dental, vision, and life benefits with employer funded HSA Paid Volunteer Community Service Days Ample opportunities for growth, advancement, and promotion 401k retirement plan with company match of 50% employee contributions up to 6% eviCore is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation

Physician / Cardiology / Texas / Permanent / Associate Medical Director - Cardiology - 100% Remote Job Job

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States. Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated. Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions. Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications. Participates in strategic planning for and evaluation of the Care Management The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Oncology Radiation, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months). Must have a minimum of 5 years clinical experience, beyond residency/fellowship Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is required No nights, no weekends, not call. Predictable work schedule Full and part time opportunities Salaried position with benefits Supportive organization with collaborative culture eviCore healthcare is committed to making a positive impact on healthcare, and also making a positive impact on our employees. eviCore offers a variety of perks and benefits including, but not limited to: Flexible scheduling and work/life balance with remote and work from home opportunities 4 weeks of PTO(starting) per year plus paid holidays One week of CME Education assistance, tuition reimbursement and professional certifications Health, dental, vision, and life benefits with employer funded HSA Paid Volunteer Community Service Days Ample opportunities for growth, advancement, and promotion 401k retirement plan with company match of 50% employee contributions up to 6% eviCore is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation

Physician / Oncology - Radiation / Texas / Permanent / Associate Medical Director - Radiation Oncology - 100% Remote Job Job

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States. Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated. Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions. Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications. Participates in strategic planning for and evaluation of the Care Management The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Oncology, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months). Must have a minimum of 5 years clinical experience, beyond residency/fellowship Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is required No nights, no weekends, not call. Predictable work schedule Full and part time opportunities Salaried position with benefits Supportive organization with collaborative culture eviCore healthcare is committed to making a positive impact on healthcare, and also making a positive impact on our employees. eviCore offers a variety of perks and benefits including, but not limited to: Flexible scheduling and work/life balance with remote and work from home opportunities 4 weeks of PTO(starting) per year plus paid holidays One week of CME Education assistance, tuition reimbursement and professional certifications Health, dental, vision, and life benefits with employer funded HSA Paid Volunteer Community Service Days Ample opportunities for growth, advancement, and promotion 401k retirement plan with company match of 50% employee contributions up to 6% eviCore is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation

Physician / Oncology / Texas / Permanent / Associate Medical Director - Oncology - 100% Remote Job Job

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States. Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated. Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions. Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications. Participates in strategic planning for and evaluation of the Care Management The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Gastroenterology, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months). Must have a minimum of 5 years clinical experience, beyond residency/fellowship Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is required No nights, no weekends, not call. Predictable work schedule Full and part time opportunities Salaried position with benefits Supportive organization with collaborative culture eviCore healthcare is committed to making a positive impact on healthcare, and also making a positive impact on our employees. eviCore offers a variety of perks and benefits including, but not limited to: Flexible scheduling and work/life balance with remote and work from home opportunities 4 weeks of PTO(starting) per year plus paid holidays One week of CME Education assistance, tuition reimbursement and professional certifications Health, dental, vision, and life benefits with employer funded HSA Paid Volunteer Community Service Days Ample opportunities for growth, advancement, and promotion 401k retirement plan with company match of 50% employee contributions up to 6% eviCore is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation

Physician / Gastroenterology / Texas / Permanent / Associate Medical Director - Gastro - 100% Remote Job Job

Explore 116+ Utilization review nurse in Texas this November. Find roles across top companies and apply now to boost your career.