11617 rn lpn jobs found

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Assist in day to day operations of clinical functions for the Post Hospital Outreach team. Act as primary liaison for clinical personnel to assist with member’s post discharge medical needs. Serve as primary point of contact for clinical personnel and department liaison when the Supervisor is not available.  Communicate with inter-department personnel for positive member resolution outcomes. Assist with daily, weekly, and monthly department reporting requirements. Assist with monthly clinical audits. Participation in clinical rounds with Medical Director.  Conduct and maintain monthly productivity expectations with post hospital outreach calls. Ability to communicate with...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals. Responsible for ensuring that all appeal letters generated comply with both State and NCQA requirements. Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services requested. Prepare reviews for cases that did not meet criteria Gather, analyze and report verbal and written information regarding member and provider clinical appeals, including information follow up Prepare response letters for member and provider clinical appeals and ensure letters are compliant with State and NCQA standards. Maintain...

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Provide facilitation, quality assessments via audits, content development, teaching and monitoring trainee’s progress. Create learning paths. Assist with developing educational platforms. Responsibilities: • Conduct training needs analyses to determine specific training needs for department staff • Identify, select, and develop appropriate training programs, including the selection or design of appropriate training aids • Evaluate effectiveness of training programs, including cost and benefit analyses • Research, analyze and recommend external training programs • Maintain records of training activities and employee progress • Assist in auditing work performed by staff and...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Perform clinical/coding medical claim review to ensure compliance with coding practices through a comprehensive review and analysis of medical claims, medical records, claims history, state regulations, contractual obligations, corporate policies and procedures and guidelines established by the American Medical Association and the Centers for Medicare and Medicaid Services. Analyze provider billing practices by utilizing code auditing software, provider documentation, administrative policies, regulatory codes, legislative directives, precedent, AMA and CMS code edit criterion. Review medical records to ensure billing is consistent with medical record for appeals, adjustments and...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Perform clinical/coding medical claim review to ensure compliance with coding practices through a comprehensive review and analysis of medical claims, medical records, claims history, state regulations, contractual obligations, corporate policies and procedures and guidelines established by the American Medical Association and the Centers for Medicare and Medicaid Services. Analyze provider billing practices by utilizing code auditing software, provider documentation, administrative policies, regulatory codes, legislative directives, precedent, AMA and CMS code edit criterion. Review medical records to ensure billing is consistent with medical record for appeals, adjustments and...

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Coordinate and monitor quality improvement and organizational projects from inception to closure. Perform duties and functions as required to develop and implement quality improvement programs and initiatives at both the corporate and individual health plan levels according to NCQA, URAC and State requirements. • Work with Director of Accreditation to assist with Plan compliance to NCQA/URAC standards. • Maintain Quality Improvement policies and procedures in compliance with NCQA/URAC requirements and recommend changes/enhancements as indicated. • Identify best practices, research new processes and recommend overall program enhancements. • Support the project life cycle...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals. Responsible for ensuring that all appeal letters generated comply with both State and NCQA requirements. • Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services requested. Prepare reviews for cases that did not meet criteria • Gather, analyze and report verbal and written information regarding member and provider clinical appeals, including information follow up • Prepare response letters for member and provider clinical appeals and ensure letters are compliant with State and NCQA standards. •...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: The Clinical Reviewer performs medical record reviews to determine the quality of care; identifies quality issues and assures compliance with medical record standards and regulatory mandates; works collaboratively with Fidelis Care New York providers and educates them on all aspects of medical record review criteria including QARR/HEDIS; conducts member and/or provider telephonic outreach when needed. Stays abreast to changes in Fidelis’ Performance Management measures and systems and changes in clinical guidelines. Perform reviews of medical records and standards; post completed review reports with the number of records reviewed and quality issues noted. Collaborate with providers...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Seeking an RN, LPN or LVN in Northern Louisiana for this Remote/Field based position. Serve as a Clinical Nurse Liaison for external groups and providers regarding clinical information from the Operations and Medical Management teams Implement and manage procedures for tracking, identifying and problem-solving operational issues Interpret and present program results and develop data-driven analysis and metrics used to measure effectiveness and ROI of all current and new products Act as the clinical representative in various meetings Collaborate with staff to identify internal and external opportunities and initiate process changes to increase quality and improve staff, provider...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals. Responsible for ensuring that all appeal letters generated comply with both State and NCQA requirements. Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services requested. Prepare reviews for cases that did not meet criteria Gather, analyze and report verbal and written information regarding member and provider clinical appeals, including information follow up Prepare response letters for member and provider clinical appeals and ensure letters are compliant with State and NCQA standards. Maintain...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: The Clinical Reviewer performs medical record reviews to determine the quality of care; identifies quality issues and assures compliance with medical record standards and regulatory mandates; works collaboratively with Fidelis Care New York providers and educates them on all aspects of medical record review criteria including QARR/HEDIS; conducts member and/or provider telephonic outreach when needed. Stays abreast to changes in Fidelis’ Performance Management measures and systems and changes in clinical guidelines. Perform reviews of medical records and standards; post completed review reports with the number of records reviewed and quality issues noted. Collaborate with providers...

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests. ***Position is REMOTE*** • Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations • Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings • Collaborate with various staff within provider...

Job Description Job Description Summary Responsible for the evaluation of donor suitability for automated pheresis procedures. Administration and supervision of approved immunizations other than red blood cell immunizations. Provides limited emergency medical care to donors and staff, including the administration of medication or treatments in accordance with licensure or certification. Job Description 1 Promotes positive customer relations with all donors. 2 Conducts confidential and effective interviews with donors to obtain necessary information regarding suitability to donate plasma. 3 In conjunction with the Center Medical Director and/or Center Physician responds to medically related questions from staff including donor suitability and provides information to staff on medically related issues. 4 Performs medical history reviews and health assessments on donors. Assesses results of donor screening and laboratory tests to determine initial and continuing donor...

Job Description Job Description Summary Responsible for the evaluation of donor suitability for automated pheresis procedures. Administration and supervision of approved immunizations other than red blood cell immunizations. Provides limited emergency medical care to donors and staff, including the administration of medication or treatments in accordance with licensure or certification. Job Description 1 Promotes positive customer relations with all donors. 2 Conducts confidential and effective interviews with donors to obtain necessary information regarding suitability to donate plasma. 3 In conjunction with the Center Medical Director and/or Center Physician responds to medically related questions from staff including donor suitability and provides information to staff on medically related issues. 4 Performs medical history reviews and health assessments on donors. Assesses results of donor screening and laboratory tests to determine initial and continuing donor...

Job Description Job Description Summary Responsible for the evaluation of donor suitability for automated pheresis procedures. Administration and supervision of approved immunizations other than red blood cell immunizations. Provides limited emergency medical care to donors and staff, including the administration of medication or treatments in accordance with licensure or certification. Job Description 1 Promotes positive customer relations with all donors. 2 Conducts confidential and effective interviews with donors to obtain necessary information regarding suitability to donate plasma. 3 In conjunction with the Center Medical Director and/or Center Physician responds to medically related questions from staff including donor suitability and provides information to staff on medically related issues. 4 Performs medical history reviews and health assessments on donors. Assesses results of donor screening and laboratory tests to determine initial and continuing donor...

Job Description Job Description Summary Responsible for the evaluation of donor suitability for automated pheresis procedures. Administration and supervision of approved immunizations other than red blood cell immunizations. Provides limited emergency medical care to donors and staff, including the administration of medication or treatments in accordance with licensure or certification. Job Description 1 Promotes positive customer relations with all donors. 2 Conducts confidential and effective interviews with donors to obtain necessary information regarding suitability to donate plasma. 3 In conjunction with the Center Medical Director and/or Center Physician responds to medically related questions from staff including donor suitability and provides information to staff on medically related issues. 4 Performs medical history reviews and health assessments on donors. Assesses results of donor screening and laboratory tests to determine initial and continuing donor...

Job Description Job Description Summary Responsible for the evaluation of donor suitability for automated pheresis procedures. Administration and supervision of approved immunizations other than red blood cell immunizations. Provides limited emergency medical care to donors and staff, including the administration of medication or treatments in accordance with licensure or certification. Job Description 1 Promotes positive customer relations with all donors. 2 Conducts confidential and effective interviews with donors to obtain necessary information regarding suitability to donate plasma. 3 In conjunction with the Center Medical Director and/or Center Physician responds to medically related questions from staff including donor suitability and provides information to staff on medically related issues. 4 Performs medical history reviews and health assessments on donors. Assesses results of donor screening and laboratory tests to determine initial and continuing donor...

Job Description Job Description Summary Responsible for the evaluation of donor suitability for automated pheresis procedures. Administration and supervision of approved immunizations other than red blood cell immunizations. Provides limited emergency medical care to donors and staff, including the administration of medication or treatments in accordance with licensure or certification. Job Description 1 Promotes positive customer relations with all donors. 2 Conducts confidential and effective interviews with donors to obtain necessary information regarding suitability to donate plasma. 3 In conjunction with the Center Medical Director and/or Center Physician responds to medically related questions from staff including donor suitability and provides information to staff on medically related issues. 4 Performs medical history reviews and health assessments on donors. Assesses results of donor screening and laboratory tests to determine initial and continuing donor...

Job Description Job Description Summary Responsible for the evaluation of donor suitability for automated pheresis procedures. Administration and supervision of approved immunizations other than red blood cell immunizations. Provides limited emergency medical care to donors and staff, including the administration of medication or treatments in accordance with licensure or certification. Job Description 1 Promotes positive customer relations with all donors. 2 Conducts confidential and effective interviews with donors to obtain necessary information regarding suitability to donate plasma. 3 In conjunction with the Center Medical Director and/or Center Physician responds to medically related questions from staff including donor suitability and provides information to staff on medically related issues. 4 Performs medical history reviews and health assessments on donors. Assesses results of donor screening and laboratory tests to determine initial and continuing donor...

Job Description Job Description Summary Responsible for the evaluation of donor suitability for automated pheresis procedures. Administration and supervision of approved immunizations other than red blood cell immunizations. Provides limited emergency medical care to donors and staff, including the administration of medication or treatments in accordance with licensure or certification. Job Description 1 Promotes positive customer relations with all donors. 2 Conducts confidential and effective interviews with donors to obtain necessary information regarding suitability to donate plasma. 3 In conjunction with the Center Medical Director and/or Center Physician responds to medically related questions from staff including donor suitability and provides information to staff on medically related issues. 4 Performs medical history reviews and health assessments on donors. Assesses results of donor screening and laboratory tests to determine initial and continuing donor...