Pre-Authorization Nurse, Humana
AI Summary: The Pre-Authorization Nurse reviews prior authorization requests for appropriate care, coordinating patient transfers and ensuring timely discharge planning. Candidates must be U.S. citizens with a current RN license and at least three years of nursing experience, particularly with TRICARE.
Clinical Appeals Nurse (Remote), CareFirst BlueCross BlueShield
AI Summary: The Clinical Appeals Nurse researches and evaluates member disputes regarding adverse coverage decisions while ensuring compliance with regulations. A valid RN license and two years of clinical experience are required, with prior appeals experience preferred.
Remote Medical Case & Peer Reviewers (RNs & Certified Healthcare Professionals – 1099), Commence
AI Summary: The position involves conducting remote clinical case reviews, focusing on medical necessity and compliance to support military families. Applicants must have at least five years of clinical experience and a valid healthcare license.
Registered Nurse RN (No direct care, assessments only), CareScout
AI Summary: As a Field Team Partner, the nurse conducts cognitive and functional assessments for older adults, utilizing a flexible schedule and digital documentation tools. A current RN license and basic technical skills are required for this contract position.
Registered Nurse job at SSM Health in IL, MO, OK, WI, SSM Health
AI Summary: The RN provides remote care while participating in program development and process improvement in various clinics. Candidates should have a nursing degree and at least one year of RN experience to fulfill department protocols and care coordination.
No User ID metadata found.