- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The RoleThe Claims Nurse Reviewer is responsible for reviewing claims , validating coding ... position requires strong clinical and medical coding skills to review claims for medical necessity, appropriate coding,...payment. The TeamAs an integral part of the Complex Claims team, the Claims Nurse … more
- Aerotek (Tempe, AZ)
- **Overview:** **Aerotek has an immediate opening for a Claims Review Specialist - Workers Compensation at the corporate office in Tempe, AZ.** **Job Summary:** ... the Workers Compensation Compliance Supervisor and Workers Compensation Compliance Manager, the Claims Review Specialist will assist in the monitoring and… more
- Travelers Insurance Company (Orlando, FL)
- …internal and/or external resources for specific activities required to effectively evaluate claims , such as Subrogation, Risk Control, nurse consultants, and ... and resolving assigned General Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim life cycle (customer… more
- Lincoln Financial Group (Columbus, OH)
- …at a Glance** We are excited to bring on highly motivated Short Term Disability Claims Specialists to staff our ever-growing claims organization. As a Short Term ... about a Day in the Life (https://www.youtube.com/watch?v=vbSYiXOPSII&feature=youtu.be) of a Claims Specialist at Lincoln Financial Group! **What you'll be doing**… more
- Office of Personnel Management (Washington, DC)
- …the health benefits Plan and providers. Consult with internal clinical advisors (eg nurse ) to resolve disputed health benefits claims and develop responses to ... Summary As a Legal Administrative Specialist (Insurance Benefits Claims Examiner), you will be part of Healthcare and Insurance, Office of Personnel Management. If… more
- Lincoln Financial Group (Boise, ID)
- …Role at a Glance** We are excited to bring on a highly motivated **Group Claims Specialist** to support our ever-growing claims organization in a work from home ... to support our west coast employer groups. _Background details_ As a Group Claims Specialist, you will support our Short Term Disability or Integrated Absence teams.… 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 Center, one...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- CDPHP (Albany, 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 ... reviews for acute and subacute rehabilitation, transportation and DME requests. Review of identified high-cost admissions and extended stays and inpatient… 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 Fulltime ... by the PA supervisor, utilizing PA software tools; + Review and authorize provider requests for the following services...PAs; + Collaborate with other OMS units to resolve claims issues that involve PAs; + Respond to questions… more
- Sedgwick (Memphis, TN)
- …Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Utilization Review Nurse **PRIMARY PURPOSE OF THE ROLE:** To utilize evidence-based ... for and recommends alternative treatment. + Collaborate effectively with physicians, claims examiners, clients, vendors, supervisors and other parties as needed. +… more
- State of Georgia (Fulton County, GA)
- …Specific, additional experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT ... Nurse Investigator Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/51086/other-jobs-matching/location-only) Hot… more
- Vighter Medical Group (El Paso, TX)
- Nurse Practitioner PT- El Paso, TX Job Details Job Location El Paso, TX - El Paso, TX Position Type Part Time Education Level Master's Degree Travel Percentage None ... Job Shift Day Job Category Health Care Description Position Description: Nurse Practitioner to perform compensation and pension examinations as a Vighter LLC employee… more
- US Tech Solutions (Columbia, SC)
- …provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate, ... effective outcomes. Responsibilities: . *50% Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit… more
- HCA Healthcare (Nashville, TN)
- …do in this role:** + Compose concise next-level appeal evaluations for disputed claims through review and assessment of clinical appeal letters, denial ... organization that invests in you as a Clinical Appeals Nurse Manager? At Parallon, you come first. HCA Healthcare...development of new and innovative methods and processes. + Review and apply contract language as necessary to resolve… more
- New York State Civil Service (New York, NY)
- …week. Medical Analysts assigned to the Claims Bureau will analyze and review claims containing allegations of medical malpractice; assist attorneys in the ... NY HELP No Agency Attorney General, Office of the Title Legal Nurse /Medical Analyst: Evaluate Med Malpractice Cases (CLA_NYC_ MA_6314) Occupational Category Legal… more
- GEHA (Lee's Summit, MO)
- …personalized customer experience, sustained by a nimble and efficient organization. The Nurse Consultant II provides professional nursing care to our members through ... of the member on how to close those gaps, review of clinical history, and review of...and/or clinical and/or plan policy development and management. The Nurse Consultant II will be involved in research and… more
- UNC Health Care (Rocky Mount, NC)
- … Review staff), and 3) reviews and appeals for hospital patient accounts/ claims denied payment through retrospective or prospective review , ie - Medicare ... and well-being of the unique communities we serve. **Summary:** The Recovery Audit Nurse will work closely with other Business Office staff members to assist in… more
- The County of Los Angeles (Los Angeles, CA)
- CLINIC LICENSED VOCATIONAL NURSE I/LICENSED VOCATIONAL NURSE I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2930097) Apply CLINIC ... LICENSED VOCATIONAL NURSE I/LICENSED VOCATIONAL NURSE I Salary $51,756.00...in preparing for the test, we advise you to review all related materials that you deem necessary. +… more
- Lowe's (Mooresville, NC)
- …Degree in Nursing and 3 years of Experience as a Case Manager or Utilization Review Nurse in worker's compensation + Associate's Degree + Experience in a ... **Job Summary** The Lowe's Care Nurse position is a telephonic medical case management...return to work, coordination of quality medical care on claims involving disability and medical treatment. Assessment and intervention,… more
- US Tech Solutions (Columbia, SC)
- …or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare continuum to ... and increase member program engagement. + Performs medical or behavioural review /authorization process. Ensures coverage for appropriate services within benefit and… more