- Molina Healthcare (Lincoln, NE)
- … and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Provides support for … more
- Cognizant (Lincoln, NE)
- …expectations. **What you need to have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...the medical necessity determinations to the Health Plan/ Medical Director based on the review of… more
- Molina Healthcare (Lincoln, NE)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal...specific programs supported by the plan such as utilization review , medical claims review , long-term… more
- Humana (Lincoln, NE)
- …concerns.** **Use your skills to make an impact** **Required Qualifications** + **Active Registered Nurse ( RN ) Multi-state/Compact State license with no ... needs at the discretion of department leadership. The Telephonic Nurse provides medical guidance, assists with access...degree in nursing (BSN) + Previous case management, utilization review , or triage experience + Previous experience in a… more
- Molina Healthcare (Lincoln, NE)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Lincoln, NE)
- For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state they reside This role will be doing Utilization review for ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… more
- Molina Healthcare (Lincoln, NE)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support...care unit, or in a telemetry type setting. UM medical review experience highly preferred. Work Hours:… more
- Molina Healthcare (Lincoln, NE)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The Care Review Clinician ( RN ) provides support for...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent… more
- Molina Healthcare (Lincoln, NE)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. **Preferred… more
- Molina Healthcare (Lincoln, NE)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Lincoln, NE)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Humana (Lincoln, NE)
- …Typical work hours are Monday-Friday, 8 hours/day, 5 days/week. **Required Qualifications** + Registered Nurse ( RN ), holding an active and unrestricted ... resources, schedules and goals. The Manager, Fraud and Waste Investigator: Nurse Audit/ Review validates and interprets medical documentation to ensure… more
- Veterans Affairs, Veterans Health Administration (Lincoln, NE)
- …patient information. Completed work should need only a general review by a registered nurse ( RN ) or physician (MD/DO) for appropriateness and conformity ... to Veterans through in-person, video, or telephone interactions, under the supervision of a Registered Nurse ( RN ) or Provider. The Specialty Medicine Clinics… more
- Veterans Affairs, Veterans Health Administration (Lincoln, NE)
- …patient information. Completed work should need only a general review by a registered nurse ( RN ) or physician (MD/DO) for appropriateness and conformity ... NE. This LPN works under the direction of an RN as a member of a Primary Care team,...to health promotion and reinforces instructions provided by the Registered Nurse and provider. Recognize the need… more
- Humana (Lincoln, NE)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and… more
- Humana (Lincoln, NE)
- …timeframe **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) Compact license, with no disciplinary action ... determination of the appropriate courses of action. The Utilization Management Behavioral Health Nurse 2 completes medical record reviews from medical … more
- Datavant (Lincoln, NE)
- …+ 3+ years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS ... you will play a pivotal role in elevating the impact of our medical record documentation. You will conduct daily evaluations and engage in direct communication… more
- Sedgwick (Lincoln, NE)
- …& Licensing** Bachelor's degree from an accredited college or university preferred. RN license required. LNC (Legal Nurse Consultant) Certification or training ... Fortune Best Workplaces in Financial Services & Insurance Professional Liability Nurse Consultant **PRIMARY PURPOSE** **:** To handle complex or high exposure… more
- CenterWell (Lincoln, NE)
- …and under established performance criteria. This is a work-from-home telephonic nurse position **Essential Functions:** + Act as CenterWell Home Health ... and complaints. + Makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data. Matches these needs to a… more
- CenterWell (Lincoln, NE)
- …community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...to make an impact** **Required Qualifications** + Active unrestricted RN license with the ability to obtain Compact Nursing… more