- The County of Los Angeles (Los Angeles, CA)
- REGISTERED NURSE I, SHERIFF (CORRECTIONAL HEALTH) Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2930992) Apply REGISTERED NURSE ... is currently offering up to 20% bonus for full-time Registered Nurse I, Sheriff positions hired by...medical specialty and subspecialty. In addition to its direct clinical services, DHS also runs the Emergency Medical Services… 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 (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
- 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
- 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 (Coralville, IA)
- …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 (Nashville, TN)
- …qualifications you will need:** + Licensed Practical / Vocational Nurse (LPN / LVN) + Registered Nurse ( RN ) + Associate Degree + No Travel Required + 1 ... you to apply! **Job Summary and Qualifications** The Compliance Nurse is responsible for providing clinical input...Compose, edit, review , or otherwise support concise clinical evaluations for disputed claims through … 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
- Guthrie (Sayre, PA)
- Summary The Registered Nurse ( RN ) Utilization Management (UM) in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices, ... of patient status. + Collaborate and set standards with registered nurse ( RN ) case managers...Adjudication + Facilitate review of rejected medical claims using clinical evidenced based tools and… more
- CareFirst (Washington, DC)
- **Resp & Qualifications** **PURPOSE:** The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and ... + Receives, researches, reviews and analyzes professional and institutional claims using critical thinking, nursing clinical judgment...High School Diploma or GED. **Licenses/Certifications Upon Hire Required:** RN - Registered Nurse -… more
- Banner Health (Scottsdale, AZ)
- … review agencies, other facilities/services, physician's offices. MINIMUM QUALIFICATIONS Requires Registered Nurse ( RN ) licensure in the state of ... review . Accurately and thoroughly completes documentation required for claims payment of services approved through concurrent review...practice. In a Behavioral Health setting requires Registered Nurse ( RN ) licensure in… 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
- CVS Health (Richmond, VA)
- …Effective communication skills, both verbal and written. Required Qualifications * Registered Nurse with current unrestricted Virginia (VA) license or ... clinical coverage policies.Fundamental Components:* Through the use of clinical tools and information/data review , conducts an... Registered Nurse with current unrestricted VA "multi-state privilege" license* Minimum… 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