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ELNA Medical Montreal, Canada Full timeCompany description · Our multidisciplinary team of healthcare professionals and our high quality clinical programs allow us to offer our patients the "Elna experience". We foster a fully integrated medical approach, centered on the patient, offering both a quick access to our s ...
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Dialogue Montreal, CanadaWhat you'll be doing · : Accompanying and monitoring patients with various health needs · Use of internal protocols · Use of your full nursing scope of practice · Collaboration with the multidisciplinary team (physicians, nurse practitioners, care coordinators, mental health oc ...
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Lakeside Care Home (Barchester) Saint-Hyacinthe, CanadaResidency5 years residency NOT requiredEmployerLakeside Care Home (Barchester)Closing date08 April 2024Reference55907ContractPermanentHoursFull TimeSalary£24.50 p/hTo provide and supervise the delivery of high quality nursing care to residents and maintain professional and clinic ...
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Extendicare St. Paul, CanadaJob Description Job DescriptionRESPONSIBILITIES Current registration with the College and Association of Registered Nurses of Alberta.Previous experience in Long Term Care preferred, which includes Complex medical and Dementia.Comprehensive knowledge of nursing and health care pr ...
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RT Medical Montréal, Canada PermanentRegistered Nurse Opportunity with RT Medical · At RT Medical, we're committed to providing the best quality services to support our patients and customers in their health and wellness needs. This commitment includes supporting all our team members however we can. Registered Nurse ...
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Bayshore HealthCare Montreal, Canada Full time, Part time, and Casual opportunities available< Licensed Practical Nurse/Registered Practical Nurse · Division: Home Care Setting: Home of patient Location: Montreal, North shore, South shore Employment Status: Full time, Part-time, and Casual opportunities available Make "being the difference" your Career at Baysho ...
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Musckids Chambly, QC, CanadaRegistered Nurse Opportunities - Procedural Areas RN page is loaded · Registered Nurse Opportunities - Procedural Areas RN · Apply locations Columbia Kershaw time type Full time posted on Posted 27 Days Ago job requisition id R Job Description Summary · *** SIGN-ON BONUSES be ...
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Registered Nurse Class B
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Vitalité Health Network Dieppe, Canada OTHERDEPARTMENT: Primary Health Care Integrated Network - Dieppe · BARGAINING UNIT: NBNU · JOB TYPE: Permanent full-time · SCHEDULE: Day, 8 and 12-hour shifts. Work schedule may be changed to meet operational needs. · LANGUAGE REQUIREMENTS: French essential and spoken English · NOTE: ...
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nurse
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CISSS de la Montérégie-Centre Longueuil, Canada Full timeEducation: College/CEGEP · Experience: Experience an asset · Work setting · Hospital or home for the aged · Hospital/medical facility or clinic · Nursing home/home for the aged · Various locations · Certificates, licences, memberships, and courses · Eligible for licensure as a R ...
Registered Nurse - Saint-Bruno-de-Montarville, Canada - TALENT Software Services
1 month ago
Description
Job Summary:
The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial.
The Medi-Cal Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role, you will perform accurate and timely clinical reviews of Member-initiated appeals.The RNs perform first-level appeal reviews for members utilizing the National Coverage Determination (NCD) guidelines, Local Coverage Determination (LCD) Guidelines, Milliman Care Guidelines, and nationally recognized sources such as NCCN and ACOG.
The successful RN candidate will review both inpatient and outpatient Medicare member appeals for benefits, medical necessity, coding accuracy and medical policy compliance.
In this role, you will also perform Clinical oversight of all Medi-Cal grievances.In this process, the candidate will work with the medical directors and coordinators to identify any Potential Quality Issues (PQI), Quality of Service (QOS) cases and/or Quality of Care (QOC) Esses to ensure member's clinical needs are addressed appropriately within days or hours if the request is deemed expedited.
Required Skills (top non-negotiables):
. Knowledge of Medi-Cal benefits and reviews
. Requires years of health insurance or related experience
. Demonstrate the ability to act independently using sound clinical judgement
Preferred Skills (nice to have)
. Works well in a fast paced team environment
. Excellent communication skills
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