- GEHA (Lee's Summit, MO)
- …a personalized customer experience, sustained by a nimble and efficient organization. The Nurse Consultant II provides professional nursing care to our members ... direct member contact and/or clinical and/or plan policy development and management. The Nurse Consultant II will be involved in research and development for… more
- Lincoln Financial Group (Columbus, OH)
- …73169 **The Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be ... for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you will...for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state… more
- CVS Health (Harrisburg, PA)
- …identification of disallowed billed charges through Internal Itemized Bill Review. This Nurse Coder position reviews hospital itemized bills to determine if all ... both internal payment policies and Medicare payment policies the Nurse Coder ensures all billed line items align with...during review of routine to complex high dollar facility claims . + Communicate with various levels of Network Management… more
- CVS Health (Columbus, OH)
- …in New Albany OH, Chandler AZ or High Point NC. Precertification Nurse Case Manager is responsible for telephonically assessing, planning, implementing and ... including co-morbid and multiple diagnoses that impact functionality.- Reviews prior claims to address potential impact on current case management and eligibility.-… more
- US Tech Solutions (Chesapeake, VA)
- …all levels to enable decision making at most appropriate level **Duties:** + Nurse Case Manager is responsible for face to face and telephonically assessing, ... including co-morbid and multiple diagnoses that impact functionality. + Reviews prior claims to address potential impact on current case management and eligibility.… more
- Grifols Shared Services North America, Inc (Clayton, NC)
- …medical authority pertaining to medical decisions which must be made. + The Staff Nurse RN consults with the national medical consultant physician but is ... solutions and services in more than 110 countries and regions. **Summary:** The Staff Nurse provides Grifols employees based in the US access to medical and health… more
- Public Consulting Group (Augusta, ME)
- **Overview** **Registered Nurse - Health Services Consultant ** **Authorization Review - Office of MaineCare Services in Augusta, ME** This role will be Fulltime ... assurance reviews of decided PAs; + Collaborate with other OMS units to resolve claims issues that involve PAs; + Respond to questions and concerns from interested… more
- Intermountain Health (St. George, UT)
- …illness or injury. This includes: Acts as a liaison for Workers Compensation claims including working with claims adjustors and providers, Develops and maintains ... of absence, and makes appropriate referrals to the long term disability program. Leadership: Coordinates ongoing employee health programs and processes. Monitors… more
- Geisinger (Wilkes-Barre, PA)
- …and extended care facility utilization reviews, medical audits, ambulatory care reviews, claims reviews, and the compliance any health care facilities within the ... in the resolution of the grievance. + Develops a consultant relationship with assigned clinics and units to build...health savings account (HSA) + Company-paid life insurance, short-term disability , and long-term disability coverage + 401(k)… more
- Carnival Cruise Line (Miami, FL)
- …preferred. (or must obtain within 1 year of hire date) + Certified Legal Nurse Consultant (CLNC) preferred. + 4 years of healthcare quality, risk management, ... a general knowledge of organizational insurance programs and resources and managing claims against the organization; interfacing with legal defense counsel and … more