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Blue Cross and Blue Shield of Kansas City
Overview
Conducts utilization management reviews to determine medical necessity and reimbursement based on clinical guidelines and member benefits. Coordinates quality, cost-effective healthcare services and collaborates with medical directors and providers to optimize member outcomes.
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Compensation
Salary not listed
Posted
2 days ago
Centene Corporation
Analyzes prior authorization requests to determine medical necessity and appropriate levels of care based on national standards and member benefits. Coordinates with healthcare providers and medical directors to ensure timely review and cost-effective medical care.
$27 - $49 / HOUR
3 days ago
Performs concurrent reviews to evaluate medical necessity, overall health, and appropriate levels of care for members. Collaborates with medical directors and healthcare providers to ensure quality continuity of care and timely discharge planning.
Elevance Health
The Clinical Review Nurse I reviews prior authorization requests and clinical documentation to determine medical necessity and benefit coverage. They collaborate with providers to obtain necessary information and escalate complex cases to leadership and physician reviewers.
5 days ago
Akido
Review and process prior authorization requests for outpatient services to ensure medical necessity and compliance with health plan requirements. Collaborate with providers and Medical Directors to document clinical determinations and maintain regulatory standards.
$62,400 - $93,600 / YEAR
8 days ago
Performs concurrent reviews to evaluate medical necessity, overall member health, and appropriate levels of care. Collaborates with medical directors and healthcare providers to ensure quality continuity of care and timely discharge planning.
11 days ago
EHE Health
The Clinical Review Nurse is responsible for reviewing patient medical reports to ensure quality, accuracy, and adherence to EHE clinical guidelines. They serve as a liaison to physicians to clarify clinical issues and ensure timely turnaround of charts.
$40 - $45 / HOUR
12 days ago
GuideWell Source
The Clinical Review Nurse reviews health claims to determine medical necessity and validity based on national and local policies. They analyze complex pre- and post-payment claims and provide education to healthcare providers regarding medical review processes.
17 days ago
