- CVS Health (Springfield, IL)
- …line with regulatory and accreditation requirements for member and/or provider claims . Independently coordinates the clinical resolution with clinician/MD support as ... including medical records and system documentation to evaluate post-service claims for payment based on clinical policies, legislation, regulatory requirements,… 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
- 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
- State of Minnesota (St. Paul, MN)
- …Title: Lead Restricted Recipient Senior Investigator** **Job Class: Human Services Program Consultant ** **Agency: Human Services Dept** + **Job ID** : 76409 + ... Restricted Recipient Program (MRRP). Experience must demonstrate the following: _._ _Registered Nurse (RN) License._ _._ _Experience working with or for a Managed… 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
- 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
- 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