Current jobs related to Utilization Management Clinical Reviewer RN - Durban, KwaZulu-Natal - VA Detroit
-
Nurse Case Manager for Veterans
5 days ago
Durban, KwaZulu-Natal, South Africa VA Detroit Full timeRequired Skills and Qualifications\To be considered for this role, you must meet the following qualifications:\\English Language Proficiency: You must be proficient in basic written and spoken English.\Graduate of a school of professional nursing approved by the appropriate accrediting agency: You must have graduated from an accredited school of professional...
-
Revenue Utilization Review Registered Nurse
3 weeks ago
Durban, KwaZulu-Natal, South Africa VA Detroit Full timeSummaryThe CPAC is a regionally consolidated business entity established to enhance revenue operations throughout the VHA network by standardization and consolidation of functions, and the integration of VHA and industry best standards.DutiesThis is an open continuous announcement until May 05, 2025. Qualified applicants will be considered and referred as...
-
Clinical Nurse Specialist Faculty
6 days ago
Durban, KwaZulu-Natal, South Africa Purdue University Online Full timeThe College of Nursing at Purdue University Online invites applications for a full-time academic position of assistant or associate professor of nursing. As a faculty member, you will play a critical role in shaping the next generation of nursing professionals.You will conduct scholarly work in your field of expertise, grant writing, teach graduate and...
-
rn-72 hour
3 weeks ago
Durban, KwaZulu-Natal, South Africa Covenant Health Full timeOverviewRegistered Nurse, Cardiology Unit$5,000 Sign-on Bonus for Experienced RNsFull Time, 72 Hours Per Pay Period, Day ShiftEvery other weekend and rotating holidaysWith more than 30 specialties from Cardiology and Neurosurgery to Orthopedics and Vascular care, Methodist Medical Center was one of the first hospitals in East Tennessee to offer cutting-edge...
-
Clinical Associate
2 weeks ago
Durban, KwaZulu-Natal, South Africa Star Nurse Educator Full timeDirect message the job poster from Star Nurse EducatorHR Strategy | Business Support #humanresources #businessdevelopmentStar Nurse Educator is a forward-thinking healthcare provider dedicated to improving the lives of patients living with chronic conditions. Our mission is to deliver compassionate, patient-centered care that empowers individuals to manage...
-
Clinical Team Manager
2 weeks ago
Durban, KwaZulu-Natal, South Africa LIFE Healthcare Group Full timeLeadership OpportunityLIFE Healthcare Group is seeking a Clinical Team Manager to lead our team in delivering exceptional healthcare services.About the RoleWe require a dedicated and compassionate Registered Nurse to provide high-quality patient care and lead our clinical team in ensuring the effective delivery of quality patient care.Main...
-
Clinical Pharmacy Manager
2 weeks ago
Durban, KwaZulu-Natal, South Africa LIFE Healthcare Group Full timeOverview:We are seeking a talented Clinical Practice Pharmacist to join our dynamic team at LIFE Healthcare Group.Key Responsibilities:You will be responsible for ensuring the quality standards, financial objectives, legislative compliance, and clinical criteria are achieved to the required standards.This includes participating in incident investigations,...
-
Clinical Service Consultant
2 weeks ago
Durban, KwaZulu-Natal, South Africa Discovery Limited Full timeAbout the RoleDiscovery Limited is seeking a highly skilled and motivated individual to fill the position of Clinical Service Consultant, as part of our Pre-Authorization team.The successful candidate will be responsible for delivering world-class service to our members, providers, and employer groups by resolving their queries through various servicing...
-
Clinical Service Advisor
1 day ago
Durban, KwaZulu-Natal, South Africa beBee Careers Full timeJob DescriptionWe are seeking a skilled Clinical Service Advisor to provide exceptional service to our members and stakeholders. The ideal candidate will have strong clinical knowledge, excellent communication skills, and the ability to work in a fast-paced environment.The successful applicant will be responsible for confirming benefits, obtaining and...
-
Clinical Operations Manager
2 days ago
Durban, KwaZulu-Natal, South Africa Findojobs South Africa Full timeInherent RequirementsA postgraduate qualification in Management or a relevant Master's Degree would be advantageous.Registration with the Health Professional Council as a therapist is essential.Maintenance of good standing with HPCSA and all applicable healthcare legislation.Compulsory BLS certification.Clinical expertise within therapy, with 3-5 years of...
-
Clinical Office Manager
1 week ago
Durban, KwaZulu-Natal, South Africa VA Detroit Full timeAdvanced Medical Support Assistant Role:We are seeking an experienced and skilled Advanced Medical Support Assistant to join our inter-professional healthcare team at the VISN Clinical Contact Center. This role offers a unique opportunity to work collaboratively with VISN programs, services, and inter-professional teams to provide access to care and meet the...
-
Clinical Trials Statistician
1 week ago
Durban, KwaZulu-Natal, South Africa MMS Holdings Inc Full timeWe are looking for a highly skilled Senior Biostatistician to join our team at MMS Holdings Inc. As a key member of our staff, you will be responsible for providing input into statistical sections and overall consistency of clinical study protocols.Some of your key responsibilities will include developing and reviewing statistical analysis plans (SAP),...
-
Clinical Practice Pharmacist
4 weeks ago
Durban, KwaZulu-Natal, South Africa LIFE Healthcare Group Full timeA vacancy exists for a Clinical Practice Pharmacist based at Life Mount Edgecombe Hospital, reporting to Andrea Muller, Pharmacy Manager. The successful candidate will be responsible for coordinating the clinical pharmacy services within the hospital by ensuring that the quality standards, financial objectives, legislative compliance and clinical criteria...
-
Clinical Practice Pharmacist
2 weeks ago
Durban, KwaZulu-Natal, South Africa LIFE Healthcare Group Full timeA vacancy exists for a Clinical Practice Pharmacist based at Life Mount Edgecombe Hospital , reporting to Andrea Muller , Pharmacy Manager . The successful candidate will be responsible for coordinating the clinical pharmacy services within the hospital by ensuring that the quality standards, financial objectives, legislative compliance and clinical...
-
Clinical Pharmacy Manager
1 week ago
Durban, KwaZulu-Natal, South Africa LIFE Healthcare Group Full timeThe successful candidate will be responsible for ensuring the quality standards, financial objectives, legislative compliance, and clinical criteria are achieved within the hospital.Critical OutputsThis position requires a high level of attention to detail, problem-solving skills, and the ability to work effectively in a dynamic environment.Medication safety...
-
Clinical Healthcare Professional
2 weeks ago
Durban, KwaZulu-Natal, South Africa National Renal Care Full timeKey ResponsibilitiesTo perform dialysis according to prescription in a safe manner and follow NRC's internal policies and procedures.To provide optimal patient care per the nursing scope of practice and NRC's clinical care pathways.Manage and maintain all medical equipment following NRC's technical policies and procedures.Ensure that all NRC quality...
-
Clinical Practice Pharmacist
2 weeks ago
Durban, KwaZulu-Natal, South Africa LIFE Healthcare Group Full timeJob Overview:LIFE Healthcare Group is seeking a highly skilled Clinical Practice Pharmacist to join their team. As a key member of the pharmacy department, you will be responsible for ensuring the quality standards, financial objectives, legislative compliance, and clinical criteria are achieved to the required standards.Critical Outputs:Effective medication...
-
Clinical Coding Specialist
1 day ago
Durban, KwaZulu-Natal, South Africa beBee Careers Full timeThe Health Information Services Manager plays a critical role in ensuring the accuracy and integrity of clinical coding data.This role requires a strong analytical mindset, attention to detail, and excellent communication skills.Key responsibilities include:Reviewing and analysing clinical coding data to identify trends and areas for improvement.Developing...
-
Pharmacist Clinical Services Coordinator
1 week ago
Durban, KwaZulu-Natal, South Africa LIFE Healthcare Group Full timeLIFE Healthcare Group is seeking a skilled and experienced Clinical Practice Pharmacist to join our team. As a key member of our healthcare team, you will be responsible for coordinating clinical pharmacy services within the hospital.Critical OutputsWe are looking for an individual with strong problem-solving skills, attention to detail, and the ability to...
-
Clinical Nurse Specialist
5 days ago
Durban, KwaZulu-Natal, South Africa Discovery Full timeAbout the RoleWe are seeking an experienced Clinical Nurse Specialist to join our team at Discovery Health. In this role, you will be responsible for providing high-quality care to patients in their own homes, utilizing your expertise in nursing and clinical skills to deliver evidence-based care.As a Clinical Nurse Specialist, you will work autonomously,...
Utilization Management Clinical Reviewer RN
3 weeks ago
Job Summary:
About the RoleWe are seeking a detail-oriented and organized Registered Nurse to join our team as a Revenue Utilization Review (RUR) Registered Nurse. As a RUR Registered Nurse, you will play a critical role in reviewing and analyzing clinical information to ensure accurate and timely reimbursement of services provided to our nation's veterans.
You will work closely with healthcare providers, third-party payers, and other stakeholders to identify and resolve complex clinical denials and ensure compliance with established guidelines.
Key Responsibilities- Review and analyze clinical information to ensure accuracy and completeness.
- Identify and address complex clinical denials in collaboration with healthcare providers and third-party payers.
- Develop and implement strategies to improve compliance with established guidelines.
- Collaborate with RUR staff to provide feedback on performance improvement and utilization management initiatives.
- Conduct precertification with third-party payers, including VA and Community Care as applicable.
- Validate Service Connection (SC) Special Authority (SA) relatedness for revenue cases.
- Manage clinical denials for revenue purposes.
- Perform legal case-relatedness review for revenue billing purposes.
- Provide education to VA medical facility providers and other staff on revenue-related topics.
- Collaborate with CPAC and VA medical facility staff on revenue cycle tasks, including Facility Revenue, Billing, Insurance Verification, Veteran Services, Compliance, Providers, Health Information Management (HIM), Utilization Management (UM), and Community Care.
- Collect, analyze, and report data related to revenue operations.
- Collaborate with third-party payers on ordered level of care and treatment plans, conducting reviews on Service Connection (SC), non-SC, Special Authority (SA), precertification, prospective review, concurrent review, denial management, retrospective review, admission, and continued stay patients.
We offer a comprehensive total rewards package that includes:
Competitive Salary
Paid Time Off: 50 days of paid time off per year, including 26 days of annual leave, 13 days of sick leave, and 11 paid federal holidays.
Retirement Benefits: Traditional federal pension and federal 401(k) with up to 5% contributions by VA.
Insurance: Federal health, vision, dental, term life, and long-term care insurance.
Licensure: Requirements vary based on location and position.
Work Schedule: Monday through Friday, 7:30am to 3:30pm, with potential for compressed or flexible schedules.
RequirementsTo be considered for this position, you must meet the following requirements:
- English Language Proficiency: In accordance with 38 U.S.C. 7403(f), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English.
- Graduate of a school of professional nursing approved by the appropriate accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE); OR Individuals attending a master's level bridge program in nursing who have completed coursework equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program. Upon achievement of a State license, the individual may be appointed on temporary basis and later converted to a permanent appointment upon successful completion and graduation from the bridge program. (Reference VA Handbook 5005, Appendix G6); OR In cases of graduates of foreign schools of professional nursing, possession of a current, full, active, and unrestricted registration will meet the requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse who has completed an associated degree/entry level Nursing education program. Credit for foreign nursing education higher than associate degree/entry level requires a formal degree equivalency validation from a recognized equivalency evaluation accepted by VA such as International Consultants of Delaware (ICD).
- Current, full, active, and unrestricted registration as a graduate professional nurse in a State, Territory or Commonwealth (i.e., Puerto Rico) of the United States, or the District of Columbia. Graduate Nurse Technician (GNT) Exception: Candidates who otherwise meet the basic education requirements, but do not possess the required licensure, may be appointed at the entry step of the grade and level applicable to the completed nursing education as a GNT on a 120-day temporary appointment while actively pursuing licensure (may be extended up to two years on a case-by-case-basis.)
This job opportunity announcement may be used to fill additional vacancies. This position is in the Excepted Service and does not confer competitive status. VA encourages persons with disabilities to apply.
