- Blue Shield of California (Long Beach, CA)
- …that track and compare patters of delegated entities. The Delegation Operations Nurse Auditor- LVN -Experienced will report to the Manager of UMDO. In this role you ... continuous quality improvement in the Utilization Management Delegation Oversight Clinical Audit ensuring that departmental and organizational goals are accomplished… more
- Sharp HealthCare (San Diego, CA)
- …1 **Shift Start Time** **Shift End Time** California Licensed Vocational Nurse ( LVN ) - CA Board of Vocational Nursing & Psychiatric Technicians; Other **Hours** ... **Required Qualifications** + Other : Graduate of an accredited Licensed Vocational Nurse ( LVN ) program + 3 Years experience in the acute patient care and/or SNF… more
- Sedgwick (Coralville, IA)
- …the need for absence from work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and ... completes medical review of all claims to ensure information substantiates disability. + Provides clear and appropriate follow-up recommendations for ongoing… more
- HCA Healthcare (Nashville, TN)
- …do in this role:** + Compose, edit, review , or otherwise support concise clinical evaluations for disputed claims through review and assessment of denial ... effective manner. + Review and apply contract language as necessary to clinical summaries. + Utilize payer administrative manuals to dispute denied claims . +… more
- Cardinal Health (Columbus, OH)
- **_What Individualized Care contributes to Cardinal Health_** Clinical Operations is responsible for providing clinical specialties support and expertise in the ... preferred + Previous social work experience is preferred + LVN is preferred + 2-4 years of Case Management...C, D) + 1-2 years of Pharmacy and/or Medical Claims billing and Coding work experience is preferred +… more
- Centene Corporation (Lansing, MI)
- …improve provider performance in areas of Quality, Risk Adjustment and Operations ( claims and encounters). + Assists in delivering provider specific metrics and ... + Partners with physicians/physician staff to find ways to encourage member clinical participation in wellness and education. + Provides resources and educational… more
