- Jobleads-US (Saddle Brook, NJ)
- …are identified and pursued and manage lien recovery on case-by-case basis. Participate in claims review process and monitor claims handling process by ... consultations above scope authority to appropriate leadership. Maintain diary for open claims and document specific claim related activities in Risk Management… more
- Morley (CA)
- …case details? If so, this role could be a perfect fit for you! As a Legal Claims Analyst at Morley, you'll play a key role in managing small automotive claims ... to support the client's defense strategies, including lemon law claims + Serve as the "Person Most Knowledgeable" (PMK)...the time + Work in partnership with the California review team (located in Michigan), evaluating vehicle buyback requests… more
- Houston Methodist Specialty Physician Group (Sugar Land, TX)
- …blood pressure, weight, and height), chief complaint(s), preforms medication(s) review , discusses/reviews medical and social history (as appropriate). ... At Houston Methodist, the Multi-Site Senior Medical Assistant, (Multi-Site Sr. MA) position is responsible...the direct supervision of a Physician, APP and/or Registered Nurse . This position oversees appropriate scope of practice, (ie… more
- Morley (Lansing, MI)
- …analyzing expense and frequency trends + Offer timely and accurate solutions for claim review + Communicate with internal and external partners through inbound ... use your customer service expertise to help automotive dealerships in Canada handle warranty claims from start to finish. **_What You'll Do_** + Be a pivotal part of… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …Friday, 8:00 AM to 5:00 PM **Pacific Time** **What you'll do:** + Performs medical necessity review that includes inpatient review , concurrent review ... . The **Care Coordinator** - **Clinical Appeals** performs prospective review (benefit advisory/ prior authorization) admission, concurrent, and retrospective… more
- Stanford Health Care (Palo Alto, CA)
- …while identifying instances of overpayments and underpayments. Proficiency in healthcare claims analysis, including the ability to review , interpret, and ... and comprehensive appeal letters to payors after a detailed review of medical records. Ensure compliance with...Spec required within 180 Days + RN - Registered Nurse - State Licensure And/Or Compact State Licensure required… more
- Morley (Atlanta, GA)
- …parts markup percentages and effective labor rates + Scan and upload documents needed for claims review + Review mailed-in documents + Offer timely and ... role)_ + See _Skills for Success_ below Tasks: + Review dealer submission of all job cards (repair orders)...your total compensation package. **_Health & Wellness Benefits_** + Medical and prescription coverage, including free annual physicals +… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …rotating Saturday shift about once every quarter.** **What you will do:** + Performs medical necessity review that includes inpatient review , concurrent ... thinking skills, along with established criteria and protocols, to determine the medical appropriateness of the clinical requests from providers and facilities. The… more
- Morley (Saginaw, MI)
- …family or school obligations **_What You'll Do_** + **Assist with contract review and management, legal research, policy development and compliance** + Provide ... comprehensive support to our legal and compliance teams + Draft, review and revise legal documents and internal policies + Manage the contract review process,… more
- Zurich NA (Schaumburg, IL)
- Medical Bill Review Senior Nurse...and resolve issues by working with corporate law, Technical Claims and other, as necessary. + Prepare, attend and ... 127127 Zurich Insurance is currently looking for a ** Medical Bill Review Senior Nurse ** to work from our Schaumburg, IL office. With limited direction,… more
- Molina Healthcare (Buffalo, NY)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... schedule) Looking for a RN with experience with appeals, claims review , and medical coding....clinical/ medical reviews of retrospective medical claim reviews, medical claims and… more
- New York State Civil Service (New York, NY)
- NY HELP No Agency Attorney General, Office of the Title Legal Nurse | Review Medical Malpractice Claims for NYS (6402) Occupational Category Legal Salary ... to the Claims Bureau will analyze and review claims containing allegations of medical...and be registered to practice as a registered professional nurse or licensed physician in New York state. It… more
- The County of Los Angeles (Los Angeles, CA)
- …REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse * or Medical Service Coordinator, CCS.** -OR- OPTION ... UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333)...needed, and to make recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review… more
- Blue KC (Workman, MN)
- …pre-transplant, transplant, and post-transplant claims . Sets up transplant pre-pay review for each individual claim . Reviews transplant billing packets and ... authorization letters, and follows in FACETS UM system in accord with UM concurrent review guidelines. Consults with Medical Director on cases outside medical… more
- Travelers Insurance Company (Irvine, CA)
- …Utilizes evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... negotiating and resolving assigned Specialty Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim … more
- Walmart (Bentonville, AR)
- …complexity** workers' compensation or general liability claims . + Secure and review initial claim reports, gather information, facts, and evidence to ... and accurate reserves; Escalate claims to the Claims Manager if claim value exceeds reserve...authority **$35,000.** + Authorize, monitor, and approve payment for medical treatment that is reasonable, necessary, and related. +… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical ...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …software for financial care activities including eligibility verifications, pre-authorizations, medical necessity, review /updating of patient accounts, etc. * ... We are currently seeking a*RCM Representative Senior*to join our Third-Party Claims -HB&PB team. This full-time role will primarily work remotely (Days, M-… more
- Martin's Point Health Care (Portland, ME)
- …performs medical necessity reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate ... Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for...for medical necessity reviews. + Manage the review of medical claims disputes,… more
- CDPHP (Latham, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care initial… more
