- US Tech Solutions (Columbia, SC)
- …Utilizes available resources to promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for ... Months Contract (Possible Extension) Job Description: Must be an RN in SC and have an active and unrestricted...Strong reading comprehension as they will read and interpret medical policies. Responsibilities: Reviews and evaluates medical … more
- County of Los Angeles, CA (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 II: ... Two (2) years of experience as a registered nurse , of which one year must...may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN … more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- Forrest General Hospital (Hattiesburg, MS)
- …of insurance claims denials. Review , manage, and resolve denied claims related to authorizations, non-coverage, medical necessity, and others as assigned ... will seek guidance from the UM physician advisor(s) for medical necessity review and final approval of...the payer's set timeframe as indicated. For cases denied, review payer's letters about the claim denied,… more
- CAMC Health System (Charleston, WV)
- …provider(s) rendering services to the patient, as directed by the provider or Registered Nurse if applicable as outlined in departmental policies and procedures. ... by policy, and disposition of calls. Retrieve, photocopy, as necessary and file medical records; prepare, review and process records to ensure completeness and… more
- A-Line Staffing Solutions (Harrisburg, PA)
- Job Description A-Line Staffing is now hiring a Hybrid Research RN . This will be full time / 40+ hours per week. If you are interested in this Hybrid Research RN ... please contact Michelle at ### or ###@alinestaffing.com Hybrid Research RN Hours 8am - 4pm (30 min lunch) 8... Responsibilities Identify discrepancies through the analysis of paid claims , itemized bills, and computer reports through the Fraud… more
- Kaiser Permanente (Downey, CA)
- …experience in quality, performance improvement, or a directly related field. Registered Nurse License (California) OR Occupational Therapist License (California) ... Description: Job Summary: Patient Safety Officer RN in acute care hospital setting. You will...action plan for areas of improvement identified through utilization review , clinical records audit, claim denials, member… more
- Blue Cross and Blue Shield of Minnesota (St. Paul, MN)
- …procedures to determine clinical appropriateness. Completes review of both medical documentation and claims data to assure appropriate resource utilization, ... to improve provider performance and member satisfaction. Required Skills and Experiences Registered nurse or licensed behavioral health clinician (ie LICSW,… more
- Regal Medical Group, Inc. (Northridge, CA)
- …Director of HROB and NICU Team. The Case Manager High Risk OB RN is directly responsible for the assessment, treatment planning, intervention, monitoring and ... contracts. The Case Manager is responsible, along with other members of Medical Management Team, for contributing to the clinical, quality, financial and patient… more
- Stormont Vail Health (Topeka, KS)
- …ratios, and proportions to practical situations. (Required proficiency) Licenses and Certifications Registered Nurse - KSBN A multistate license with the ability ... per week: 36 Job Information Exemption Status: Non-Exempt A Brief Overview Medical /Surgical nursing is a specialty within the nursing profession that encompasses the… more
- County of Los Angeles, CA (Los Angeles, CA)
- …practice as a clinical social worker, marriage and family therapist, psychologist, or registered nurse issued by the appropriate State of California licensing ... practice as a clinical social worker, marriage and family therapist, psychologist, or registered nurse issued by the appropriate State of California licensing… more
- Constructive Partnerships Unlimited (New York, NY)
- …managing the care of the people we serve. QUALIFICATIONS: 1. A NYS-Licensed Professional Registered Nurse with current license in good standing. 2. Bachelor's of ... ensure that all team members are aware of all medical conditions and care. 8. Review reports...investigations and reviews. SUPERVISES : Nurse Educators Nurse Case Managers (NCM) Medical Case Manager… more
- VA Boston Healthcare System (Boston, MA)
- …appointments. Telephone and video care are encouraged. Each physician is assigned a registered nurse , clinical associate, and scheduler. There is no call, and ... the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible...are seeking an enthusiastic internist with a passion for medical education for a full time position as … more
- The Overlook (Charlton, MA)
- …claims integrity and clinical claims oversight. Performs duties of a registered nurse . Other responsibilities as assigned by the Executive Director of ... variety of means such as home visits, conferences, record review , etc. Provides feedback to Team Members to enhance...degree in Nursing - required *Master's Degree - preferred * Registered Nurse with current licensure to practice… more
- Allegheny County (Pittsburgh, PA)
- …a Public Health Nurse . AND License Requirement Possession of a license as a registered nurse as issued by the Pennsylvania State Board of Nurse Examiners ... will be required to travel. If hired, the NFP Nurse will be required to sign a training reimbursement...a copy of your official college transcripts for your claim to be accepted. Unofficial Transcripts will not be… more
- Macpower Digital Assets Edge (Downey, CA)
- …standards for corrective action plan for improvement identified through utilization review , clinical records audit, claim denials, patient satisfaction surveys, ... you will be responsible for Risk Management and Patient Safety for large medical center and also responsible for leading Situation Management Team to facilitate the… more
- Telecare (Riverside, CA)
- …policies and procedures; organizes the department to meet legal, organizational and medical staff guidelines; and functions in an advisory capacity to the ... safety program and actively participates in reducing workers' compensation claims *Adheres to standards for procurement of supplies and...in a supervisory capacity *Current valid licensure as an RN in the state the program resides *Must be… 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 (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
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