Nurse Jobs in San Juan, Puerto Rico

33 jobs

Responsible for the management of inpatient concurrent review services provided to new born intensive care members with a focus on discharge planning and follow-up for 30 days post discharge to prevent unplanned readmissions. . Functions as a clinical resource for other licensed and non-licensed UM staff, interacts with Medical Directors, professional staff, providers, and care givers to attain hi...

Clinical Advisor RN with license/Office (Fully Bilingual, Health Insurance, CMS's Audit exp. a MUST) - San Juan Requisition ID 144088 Business Overview Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consume...

Clinical Advisor RN with license (Office)- Bilingual - San Juan Requisition ID 144476 Business Overview Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-...

Job SummaryTo provide clinical expertise in the application of medical and reimbursement policies within the claim adjudication process through claim review, medical record review and research. To provide expert knowledge in CMS, NCCI, AMA and other nationally published guidelines for correct coding and billing accuracy. Essential Functions• Evaluates medical records and/or medical notes providin...

Clinical Advisor RN with license (Office)- Bilingual - San Juan Requisition ID 140872 Business Overview Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-...

LPN Clinic Office-1521894 Description Administers nursing care in an outpatient facility or clinic under the supervision of a registered nurse. Participates in the delivery and evaluation of patient care. Ensures the health, comfort and safety of patients. Relies on experience and judgment to plan and accomplish goals. Performs a variety of tasks. Works under general supervision. A certain degre...

LPN - Palmetto Tri-County - Full TIme - Days-1522253 About us: Springs Memorial Hospital, a 213-bed, all-private, acute-care facility, is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and certified by the American Heart Association as a "Get With the Guidelines" facility. It is a progressive, community-oriented organization offering such services as 24-h...

You’re a nurse, a patient advocate and an educator—and you excel at every one of them. If there’s one thing your years of clinical training and patient education have taught you, it’s how to manage priorities, and move seamlessly from one challenge to the next. You get people to listen to your wise advice, and to overcome their fears of new and existing medical therapies by instilling confidence a...

Overview: The VITAS Nurse is a member of the interdisciplinary team and is the pivotal person in identifying the physical, psychological, social and spiritual needs of the patient and family. Responsible for initiating the appropriate intervention and support for the patient and family upon admission to VITAS and provides a continuously appropriate, comprehensive and responsive plan of care. Qua...

Role: Clinical Innovations / Clinical Advisor, RN Assignment: Location: San Juan Are you a fit? Do you enjoy working with medical members? Do you have a desire to be in a position where you can provide guidance to our member population as it is related to their health care needs? If so then read on! Assignment Capsule You will collaborate with other health care givers in reviewing actual and...

Job Summary To provide clinical expertise in the application of medical and reimbursement policies within the claim adjudication process through claim review, medical record review and research. To provide expert knowledge in CMS, NCCI, AMA and other nationally published guidelines for correct coding and billing accuracy. Essential Functions • Evaluates medical records and/or medical notes provid...

Job Summary Works with the Utilization Management team and is primarily responsible for prior authorizations. According to guidelines provides inpatient and outpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Assesses services for Molina Members to ensure ...

Job SummaryThe Case Manager is responsible for providing utilization review and discharge planning services which positively impacts client wellness and autonomy through advocacy, communication, education, identification of service resources, and service facilitation. The Case Manager is responsible to ensure available resources are being used in a timely and cost-effective manner in order to obta...

Job Summary Works with the Utilization Management team and is primarily responsible for prior authorizations. According to guidelines provides inpatient and outpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Assesses services for Molina Members to ensure ...

Job Summary The Case Manager is responsible for providing utilization review and discharge planning services which positively impacts client wellness and autonomy through advocacy, communication, education, identification of service resources, and service facilitation. The Case Manager is responsible to ensure available resources are being used in a timely and cost-effective manner in order to obt...

Job Summary Works with the Utilization Management team and is primarily responsible for prior authorizations. According to guidelines provides inpatient and outpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Assesses services for Molina Members to ensure ...

As the only global provider of commercial solutions, Quintiles understands what it takes to deliver nationally and internationally. Our teams help biopharma get their medicines to the people who need them. We help customers gain insight and access to their markets and ultimately demonstrate their product’s value to payers, physicians and patients. A significant part of our business is acting as th...

Puerto Rico Medical Director Requisition ID 142476 Business Overview Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities fo...

Job Summary Creates and manages the required documentation for QI Compliance. Essential Functions Conduct review and investigation of potential quality of care issues in collaboration with dedicated clinical and non-clinical health plan staff in the Quality and other departments • Gather and review medical records from providers and facilities to complete activities related to quality of care ...

Job Summary Assists the Director with ensuring the Molina Medicaid plans maintain NCQA Accreditation and bring new or acquired plan to NCQA Accredited status. The Manager maintains tracking of State QI activities and ensures timely completion within appropriate Corporate standards. The Manager maintains the library of accreditation and regulatory updates from NCQA, CMS and state regulators. The M...