- Sharp HealthCare (San Diego, CA)
- …1 **Shift Start Time** **Shift End Time** California Licensed Vocational Nurse ( LVN ) - CA Board of Vocational Nursing & Psychiatric Technicians; Other **Hours** ... **Required Qualifications** + Other : Graduate of an accredited Licensed Vocational Nurse ( LVN ) program + 3 Years experience in the acute patient care and/or SNF… 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
- Molina Healthcare (Columbia, SC)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or ... likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
- Centene Corporation (Omaha, NE)
- …improve provider performance in areas of Quality, Risk Adjustment and Operations ( claims and encounters). + Assists in delivering provider specific metrics and ... + Partners with physicians/physician staff to find ways to encourage member clinical participation in wellness and education. + Provides resources and educational… more
- Elevance Health (Mount Juliet, TN)
- …the care continuum. + Responsible for performing telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of ... + May also assist in problem solving with providers, claims or service issues. + Directs and/or supervises the...issues. + Directs and/or supervises the work of any LPN/ LVN , LSW, LCSW, LMSW, and other licensed professionals other… more
- Elevance Health (Brooklyn, NY)
- …you will make an impact:** + Responsible for performing telephonic clinical assessments for the identification, evaluation, coordination and management of member's ... + May also assist in problem solving with providers, claims or service issues. + Directs and/or supervises the...issues. + Directs and/or supervises the work of any LPN/ LVN , LSW, LCSW, LMSW, and other licensed professionals other… more