- CNO Financial Group (Carmel, IN)
- …in a remote setting. You'll meet the needs of individuals in a non- clinical environment. **As a Registered Nurse Advocate,** **your responsibilities ... advocates and members. In this capacity, you'll leverage your clinical expertise to aid members in navigating various health-related...in nursing (BSN) from an accredited institution + Active registered nurse ( RN ) license in… more
- HCA Healthcare (Charleston, SC)
- …our colleagues in their positions. Join our team as an **Employee Health Registered Nurse ** in the beautify city of Charleston, South Carolina. **Benefits** ... Trident Medical Center! **Job Summary and Qualifications** The **Employee Health Registered Nurse ** is responsible for delivering high quality, patient-centered… 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...You will partner with hospitals and providers to conduct clinical reviews of members using the Emergency Department (ED)… more
- Sutter Health (Burlingame, CA)
- …: **EDUCATION:** Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** RN - Registered Nurse of California Upon Hire CCM certification ... team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and… more
- Sutter Health (Modesto, CA)
- …accepted in lieu of the required degree or diploma. **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California Upon Hire **TYPICAL EXPERIENCE:** + 3 ... team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and… more
- Access Dubuque (Dubuque, IA)
- …the need for absence from work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and ... Disability Clinical Specialists **Sedgwick** 1 Positions ID: R49038 Posted...completes medical review of all claims to ensure information substantiates disability. + Provides clear… more
- Sedgwick (Austin, TX)
- …the need for absence from work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and ... completes medical review of all claims to ensure information substantiates disability. + Provides clear and appropriate follow-up recommendations for ongoing… more
- HCA Healthcare (Richmond, VA)
- …we encourage you to apply for our Revenue Integrity Clinical Analyst RN opening. We promptly review all applications. Highly qualified candidates will be ... like family! Jump-start your career as a Revenue Integrity Clinical Analyst RN today with Revenue Integrity....experience in charging or performing charge reviews + Active Registered Nurse License or other advanced nursing… more
- Molina Healthcare (Columbia, SC)
- **JOB DESCRIPTION** For this position we are seeking a ( RN ) Registered Nurse who must be licensed in the state you reside. We are looking for a Clinical ... for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs...specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long… more
- Trinity Health (Fresno, CA)
- …of Science in Nursing (BSN) is preferred. 2. Current licensure as a Registered Nurse authorized in the applicable state(s) of practice/employment is required. ... identifies major trending patterns. This position analyzes allegations of claims and complaints against the organization, and corresponding documentation...3. Five (5) years of clinical experience as an RN is required.… more
- Providence (Irvine, CA)
- …and payer logistical perspective. Works closely with the Clinical Denial RN and support staff to review denied accounts, prepare rebuttals, discuss ... **Description** ** Claims Appeals Representative \*Remote * Candidates in AK,...monitor outcomes of follow-up activities. Works closely with the Clinical Denial RN on nuances associated with… more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... policy and operating procedures are accurately operationalized for optimal claims adjudication and utilization management. **We are looking for...State Licensure Registered Nurse ( RN ) Upon Hire Required and +… 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)
- …with the cost effective utilization of resources. + You will perform concurrent clinical review to determine appropriateness of admission and continued need for ... facilities those services required. + You will perform telephonic clinical reviews with claims insurance personnel to...Current licensure in the State of Colorado as a Registered Nurse , or current active multistate … more
- Covenant Health Inc. (Morristown, TN)
- …computers; skill in Microsoft Excel and Access. Licensure Requirement: Current state registered nurse license. Certified Oncology Nurse strongly preferred. ... Overview RN Manager of Oncology Clinic & Infusion Center...80 Hours Per Pay Period, Day Shift Responsible for Clinical Oversite of Medical Oncology Clinic and Infusion centers… more
- Public Consulting Group (Council Bluffs, IA)
- …to successfully monitor and ensure the quality of data analytic and clinical review activities. + Knowledge of claims and medical record review data ... for coordinating program integrity-related reviews with the medical necessity review team responsible for conducting medical necessity reviews, ensuring services… more
- Providence (Portland, OR)
- … teams: + Prior-authorization (PA) + Concurrent Review (CCR) + SNF + Clinical Claims + Provider Reconsideration + Member Appeals + Medical + Coding + ... configuration + Critically assess and prepare all cases for RN /MD review of coverage (medical necessity, eligibility,...all lines of business + Responsible for ensuring service review requests and clinical inquiries are complete… more
- HCA Healthcare (Lone Tree, CO)
- …and psychosocial approach through the continuum of care. + Performs concurrent clinical review to determine appropriateness of admission and continued need ... delivery in the acute care setting. + Performs telephonic clinical reviews with claims insurance personnel to...Current licensure in the State of Colorado as a Registered Nurse , or current active multistate nursing… more
- Sutter Health (San Francisco, CA)
- …Master in nursing, case management or related field. **CERTIFICATION & LICENSURE** + RN - Registered Nurse of California (required) + CCM-Certified Case ... team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and… more
- CVS Health (Richmond, VA)
- …* Effective communication skills, both verbal and written. Required Qualifications * Registered Nurse with current unrestricted Virginia (VA) license or VA ... reimbursement policy . Monday-Friday 8am-5pm EST. The Case Manager RN (CM RN ) is responsible for telephonically...coverage policies. Fundamental Components: * Through the use of clinical tools and information/data review , conducts an… more