- Optum (San Juan, PR)
- …at the end of the day, we're doing a lot of good. The objective of the Clinical Case Review - RN or Certified Medical Coder is to help reduce the medical ... must demonstrate an ability to maneuver through all applicable claims applications (COSMOS, UNET, Facets, Pulse, etc.), and over...Experience with Fraud Waste & Abuse or Payment Integrity Medical record review experience Knowledge of health… more
- Optum (San Juan, PR)
- …as provide development for other roles you may be interested in. Required Qualifications: Registered Nurse ( RN ), Coding Certificate or Nursing Licensure, for ... Perform clinical review of professional (or facility) claims vs. medical records to determine if...example: Puerto Rico Registered Nurse Certified Professional Coder (CPC) +… more
- Ascension (Baltimore, MD)
- …management rules and regulations. Requirements Licensure / Certification / Registration: Registered Nurse credentialed from the Maryland Board of Nursing ... management rules and regulations. Qualifications Licensure / Certification / Registration: Registered Nurse credentialed from the Maryland Board of Nursing… more
- State of Florida (Orlando, FL)
- …all verbal orders, including telephone orders from attending physicians, are reviewed by a registered nurse . If no RN is available, receive all telephone ... reflective of resident's status, and providing supervision and guidance to the Registered ( RN ), Licensed Practical Nurse (LPN), Certified Nursing… more
- American Health Partners (Acworth, GA)
- …to change and be able to collaborate with multiple teams JOB SUMMARY: The Registered Nurse Case Manager is responsible for providing daily management and support ... Coordination program *Perform improvement projects involving development of monitoring/collection tools, review of medical records, data entry, analysis, and… more
- Corvel (Tallahassee, FL)
- …return-to-work if appropriate. The Telephonic Case Manager will rely on their medical knowledge to evaluate the patient's current treatment plan for medical ... The Telephonic Case Manager must be able to discuss the patient's medical and physical conditions with the treating physicians, along with discussing/ recommending… more
- Trinity Health (Boise, ID)
- … and complaints against the organization, and corresponding documentation (including medical record review , security reports/video, etc.). Analyzes Event reports ... Type: Full time Shift: Day Shift Description: CLINICAL RISK MANAGER BOISE REGIONAL MEDICAL CENTER, Level II Trauma Center SUMMARY: The Clinical Risk Manager is to… more
- Zenith (Sarasota, FL)
- …coding and bill auditing experience. Experience with/understanding of utilization/bill review , claims , managed care processing; Workers' Compensation Bill ... This position can be filled in ANY Zenith Branch Responsible for clinical review and analysis and appropriate adjustment of billing as needed based on Workers… more
- Jamie Grayem (Downey, CA)
- …standards for corrective action plan for improvement identified through utilization review , clinical records audit, claim denials, patient satisfaction surveys, ... changes to the reimbursement structure, and the impacts of changes in medical science to hospital performance, among others; maintaining a culture of continuous… more
- Kaiser Permanente (Redwood City, CA)
- …Preferred Qualifications: Health care clinical license from the practicing/applicable state (eg, Registered Nurse ( RN ), Registered Pharmacist (RPh), ... standards for corrective action plans for improvement identified through utilization review , clinical records audit, claim denials, patient satisfaction surveys,… more
- Danbury Westerville (Westerville, OH)
- …considered for this position. Responsibilities include but are not limited to: As an RN or LPN, you would plan, organize, develop and direct the overall operation of ... assignments. Participate in surveys made by authorized government agencies as necessary. Review nurses notes to ensure that they are informative and descriptive and… more
- State of Connecticut, Department of Administrative Services (New Haven, CT)
- … medical treatment facility, in rehabilitative or occupational nursing or providing medical review of insurance claims . MINIMUM QUALIFICATIONS - ... Utilization Review Nurse (40 Hour) Office/On-Site Recruitment...(https://www.jobapscloud.com/CT/jobs/?b=Benefits) + + + + Introduction Are you a Registered Nurse looking for an opportunity to… more
- Houston Methodist (Sugar Land, TX)
- …the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse ( RN ) who comprehensively conducts point of entry and ... concurrent medical record review for medical ...in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse ( RN ) who comprehensively conducts point of entry and ... concurrent medical record review for medical ...in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse - Payment Integrity Nurse Coder RN III Job Category: Clinical Department: Claims Integrity Location: Los Angeles, CA, US, 90017 ... policies within the claim adjudication process through medical record review for Payment Integrity and...Office suite, including Word, Excel and PowerPoint. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- InGenesis (Columbia, SC)
- InGenesis is currently seeking a Registered Nurse / RN - Managed Care Coordinator to work for our client located in Columbia, SC. In this role you will ... any questions you may have. Job Duties * Perform medical review /authorization process. * Ensure coverage for...Perform other duties as assigned. Minimum Qualifications * Current Registered Nurse / RN license… more
- Ascension Health (Wichita, KS)
- …rules and regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Kansas Board of Nursing ... **Details** + **Department:** Utilization Review + **Schedule:** Full time, 36 hrs, Day...+ Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.… more
- AdventHealth (Altamonte Springs, FL)
- …Remote **The role youll contribute:** A Workers Comp Support Registered Nurse is responsible for providing telephonic medical case management for Workers ... Independent Medical Examinations or submitting formal Utilization Review with clinical director and claims adjuster...is essential **LICENSURE, CERTIFICATION, OR REGISTRATION REQUIRED:** + Active Registered Nurse ( RN ) license in… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... protocol sets, or clinical guidelines and provide support and review of medical claims and...customer service skills required. **Minimum License Requirement :** California RN license. Delivering world-class health care one patient at… more
- Commonwealth of Pennsylvania (PA)
- Registered Nurse Supervisor (2nd Shift) - Selinsgrove Center Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5002155) Apply Registered ... compassionate individual to grow their leadership skills as a Registered Nurse Supervisor. In this role, you...services. You can expect to participate in the development, review , training and implementation of center policies and procedures.… more
