CharlestonRecruiter Since 2001
the smart solution for Charleston jobs

RN Clinical Care Reviewer

Company: ZolonTech
Location: Charleston
Posted on: June 14, 2019

Job Description:

Current, unrestricted SC Registered Nurse license. 2+ years experience in utilization management, preferably within managed care. Comfortable utilizing MS Office products, including Excel, Word, and Outlook. CONTRACT - 3 + months Responsibilities: Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review. It is within the nurse's discretion to pending requests for additional information and/or request clarification. The nurse will use his/her professional judgment to evaluate the request to ensure that appropriate services are approved and recognize care coordination opportunities and refer those cases as needed. The nurse will apply medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer requests to the Medical Director when guidelines are not met. The nurse will maintain current knowledge and understanding of the laws, regulations, and policies that pertain to the organizational unit's business and uses clinical judgment in their application.

Keywords: ZolonTech, Charleston , RN Clinical Care Reviewer, Other , Charleston, South Carolina

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Other Jobs


Rental Sales Associate
Description: CUSTOMER SERVICE SALES REPRESENTATIVE --- CONNECT WITH OUR CUSTOMERS IN MOMENTS THAT MATTER Additional earnings potential as much as 3 times your annual base salary Do you want to get into sales With (more...)
Company: Avis Budget Group
Location: Savannah
Posted on: 06/25/2019

Virtual Receptionist (Many Openings)
Description: Virtual Receptionist Needed Many Openings Our clients are busy, small business owners who hire us to handle their phone calls and treat their customers the way they would. Our job is to answer those (more...)
Company: Mommy Jobs On Line
Location: Charleston
Posted on: 06/25/2019

Security Professional
Description: Position Title: RMF Analyst Summary of Specific Duties: Athena Consulting Group, LLC. is looking for an experienced analyst with 8 years of DIACAP / RMF experience and a strong knowledge of DISA STIGs (more...)
Company: Athena Consulting Group (ACG)
Location: Charleston
Posted on: 06/25/2019


Looking For A Career Change!
Description: The Largest Healthcare Benefits Discount Company is seeking Representatives that want to work from
Company: MAH Benefits
Location: Charleston
Posted on: 06/25/2019

Wanted! Professional Customer Service Personnel
Description: Our nation's premier provider of health care access in the US is looking for motivated self-starters to enjoy a career with our company. Our health care programs are primarily
Company: Health Inc.
Location: Savannah
Posted on: 06/25/2019

Current College Students - Adobe Student Group Partnership
Description: What We're Looking For: A dynamic student group on campus with a working knowledge of Adobe CC, your members have strong connections with other
Company: The Campus Agency
Location: Charleston
Posted on: 06/25/2019

Supervisor
Description: Requisition Number: br 4073 br Division: br Retail Store Operations br Employment Duration: br Part time br Employment Status: br Regular br Shift: br Varied br br Company Overview (more...)
Company: BOARDRIDERS
Location: Charleston
Posted on: 06/25/2019

Are You Tired Of Sitting In Traffic? Work From Home
Description: Our Company is recommended by and has an A rating with the Better Business Bureau. We will be conducting interviews all week. We currently have two positions available. We are looking for people that (more...)
Company: AP USA
Location: Savannah
Posted on: 06/25/2019

Executive Assistant
Description: Mommy Jobs Online is looking for an experienced Executive Assistant to partner with the senior most members of our team. You'll help leaders in the company to be more effective by coordinating schedules, (more...)
Company: Mommy Jobs Online
Location: Savannah
Posted on: 06/25/2019

Medical Transcriptionist
Description: NEW Medical Transcription We have a few openings for full-time HIM MTs on the 2nd and 3rd shifts. These positions would be Monday through Friday and would work every 3rd weekend both Saturday and Sunday (more...)
Company: Mommy Jobs Online
Location: Charleston
Posted on: 06/25/2019

Log In or Create An Account

Get the latest South Carolina jobs by following @recnetSC on Twitter!

Charleston RSS job feeds