- 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 (Warren, MI)
- …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
- Molina Healthcare (Long Beach, CA)
- …clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review . **Required License, Certification, Association** Active, ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...of proactive approaches to improve and standardize overall retrospective claims review . * Ensures core system is… more
- Travelers Insurance Company (Walnut Creek, 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
- 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
- Baylor Scott & White Health (Dallas, TX)
- …of lost wages for payroll and for all approvals of medical bills per claim file. + Pay and process claims within designated authority level. + Performs other ... and/or level **Job Summary** + Under the Safe Choice Claims Manager, the Safe Choice Claims Specialist...Establish reserve requirements. Identify subrogation potential. Maintain diary. + Review and evaluate medical and lost wages.… 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. * ... *SUMMARY:* 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
- State of Connecticut, Department of Administrative Services (Hartford, 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...third-party administrator files to oversee contractor handling; + May review medical records of various health care… more
- Houston Methodist (Houston, TX)
- …This position has achieved an expert level at all objectives delineated in the Utilization Review Nurse and Utilization Review Specialist Nurse job roles ... At Houston Methodist, the Sr Utilization Review Specialist Nurse (URSN) position is...Functions as a resource to department staff in communicating medical information required by external review entities,… 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 a member of...for medical necessity reviews. + Manage the review of medical claims disputes,… more
- Idaho Division of Human Resources (Nampa, ID)
- Utilization Review and Nurse Educator - SHW Posting Begin Date: 2025/09/22 Posting End Date: 2025/10/20 Category: Nursing Work Type: Full Time Location: Nampa, ... found here: https://dhr.idaho.gov/StateEmployees/Benefits.html.* EXAMPLE OF DUTIES: + Coordinate Utilization Review Services to assess medical necessity, level… 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
- Commonwealth of Pennsylvania (PA)
- Health Care Nurse Surveyor - Williamsport Field Office Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5098714) Apply Health Care Nurse ... Nursing Care Facilities is seeking a motivated Health Care Nurse Surveyor. If you want to make a lasting...quality of care and services, determine eligibility for licensure, review reported incidents, and recommend correction plans. You will… more
- Staffing Solutions Organization (Augusta, ME)
- …workforce, which is a reflection of our clients and the people they serve. **Registered Nurse - Authorization Review Unit - Maine DHHS in Augusta, ME** **This ... a week onsite in Augusta.** **Position Duties:** + Manage medical Prior Authorizations (PA) as assigned by the PA...by the PA supervisor, utilizing PA software tools. + Review and authorize provider requests for the following services… more
- Centene Corporation (New York, NY)
- …license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for ... and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review and… more
- Lincoln Financial (Hagatna, GU)
- …organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you ... will act as a clinical resource for Group Protection benefit specialists and claim professionals. You will evaluate medical information to clarify diagnoses,… more
- AdventHealth (Riverview, FL)
- …be caring for:** AdventHealth Riverview AdventHealth is expanding our medical expertise, innovation, and state-of-the-art technology to southern Hillsborough County ... million project in Riverview also includes a 100,000 square foot, four-story Medical Office Building that will provide community members convenient access to expert… more