- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …the claims according to appropriate guidelines. This position requires strong clinical and medical coding skills to review claims for medical ... Nurse Reviewer is responsible for reviewing claims , validating coding and medical necessity of...with Provider Service, Claims , Network Management, Physician Review , and Medical and Payment Policy teams.… more
- Public Consulting Group (Council Bluffs, IA)
- …ensure the quality of data analytic and clinical review activities. + Knowledge of claims and medical record review data across provider service types. + ... **Responsibilities** + Responsible for coordinating program integrity-related reviews with the medical necessity review team responsible for conducting … more
- Houston Methodist (Houston, TX)
- …to department specifications. + Manages utilization management (UM) programs including Medical Claims Review , Precertification and Reconsiderations and ... efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and exceed...progressive leadership abilities **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- Beth Israel Lahey Health (Winchester, MA)
- …Occupational Health Nurse preferred. **LICENSE, CERTIFICATION REQUIRED:** Massachusetts Registered Nurse license. Certification as an Occupational Health ... Bachelor's degree in Nursing. Bachelor's degree in Nursing preferred. 2. At least three years work experience as a medical or surgical staff nurse . 3. Certified… 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 ... + Ability to develop and implement corrective actions. **Minimum Qualifications:** + Registered Nurse and three (3) years of progressively responsible experience… more
- The County of Los Angeles (Los Angeles, CA)
- REGISTERED NURSE I, SHERIFF (CORRECTIONAL HEALTH) Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2930992) Apply REGISTERED NURSE ... is currently offering up to 20% bonus for full-time Registered Nurse I, Sheriff positions hired by...vaccination against COVID-19 or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates… more
- CNO Financial Group (Carmel, IN)
- …need:** + Bachelor's degree in nursing (BSN) from an accredited institution + Active registered nurse ( RN ) license in [state/country of employment]. + Three ... Optavise, a CNO Financial Group Company is seeking a Registered Nurse Advocate to take on a...address them effectively. + Evaluate prior authorization requests for medical necessity and review medical … more
- Public Consulting Group (Augusta, ME)
- …delivery of health care services. LICENSING/REGISTRATION/CERTIFICATION REQUIREMENTS: Licensed as a Registered Professional Nurse ( RN ) or Licensed Practical ... **Overview** ** Registered Nurse - Emergency Department Collaborative...the Emergency Department (ED) for avoidable reasons identified through claims data and ED daily census. You will educate… more
- Sutter Health (Auburn, CA)
- …or Health related field or equivalent education/experience **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California Upon Hire **TYPICAL ... position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to...services, third party payers and review agencies, claims and finance departments, Medical Directors, and… more
- Sutter Health (Burlingame, CA)
- …: **EDUCATION:** Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** RN - Registered Nurse of California Upon Hire CCM certification ... position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to...services, third party payers and review agencies, claims and finance departments, Medical Directors, and… more
- LA Care Health Plan (Los Angeles, CA)
- …and Physician Advisor on case reviews for pre-service, concurrent, post-service and retrospective claims medical review . Monitors and oversees the collection ... requirements for health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted… 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 ... for medical necessity reviews. + Manage the review of medical claims disputes,...and offerings. Education/Experience: + Unrestricted state license as a Registered Nurse required; BSN preferred. + 3+… more
- Sedgwick (Columbus, OH)
- …- Liability **PRIMARY PURPOSE** **:** To manage complex high exposure general liability claims ; to review medical treatment records associated with general ... unrelated medical specials; provides analysis and recommendations for further claims handling. + Creates a working chronology that, as required, also includes… more
- Banner Health (AZ)
- …the ability to work well as a part of a team. PREFERRED QUALIFICATIONS Registered nurse with active licensure with clinical experience is preferred. In-house ... focused on enhancing processes and maximizing efficiency with the review and management of claims and litigation...management of claims and litigation matters. Paralegal, claims adjustor experience, medical litigation experience is… more
- Access Dubuque (Dubuque, IA)
- …Service Representative (PRN) Grand River Medical Group Processor TRICOR, LLC Biologic Nurse ( RN /LPN) Grand River Medical Group Account Manager Kunkel & ... management reports and takes appropriate action. + Performs quality review on claims in compliance with audit...benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... **Resp & Qualifications** **PURPOSE:** In collaboration with the Medical Director, the Senior Medical Policy...State Licensure Registered Nurse ( RN ) Upon Hire Required and +… more
- AdventHealth (Altamonte Springs, FL)
- …: Remote **The role you'll contribute:** . The role of the Utilization Management (UM) Registered Nurse ( RN ) is to use clinical expertise by analyzing . ... resolutions of conflicts between status and authorization. Evaluates clinical review (s) and physician documentation for at-risk claims ;.... Current and valid license to practice as a Registered Nurse (ADN or BSN) required. .… more
- Access Dubuque (Dubuque, IA)
- Claims Representative - Auto **Sedgwick** 1 Positions ID:...River Medical Group Processor TRICOR, LLC Biologic Nurse ( RN /LPN) Grand River Medical ... to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Representative - Auto **PRIMARY PURPOSE** : To analyze and process low… more
- Peak Vista (Colorado Springs, CO)
- …Education: Bachelors' degree in business or health care related field preferred. Registered Nurse preferred. Work Experience: Four (4) years of experience ... such as incident reporting processes, root cause analysis, risk assessments, audits, review of patient complaints, analysis of trends, claims analysis and… more
- HCA Healthcare (Thornton, CO)
- …qualifications you will need:** + Current licensure in the State of Colorado as a Registered Nurse , or current active multistate Registered Nurse ... typical candidate is hired below midpoint of the range. ** RN Case Manager PRN** **Weekday, Weekend and Holiday Availability...orientate about 2-4 shifts for 3 weeks during weekday** ** Medical Case Management with Discharge Planning** Do you want… more