- Rising Medical Solutions (Chicago, IL)
- …direction for Rising's Specialty Services unit involving complex/large medical claims ; analyzing and optimizing bill review procedures and systems; and ... leading a team of experienced medical bill review auditors, nurse ...equivalent required + Minimum five years of financial analysis/business, medical claims adjusting background preferably in Workers… more
- Travelers Insurance Company (Diamond Bar, CA)
- …Utilizes evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... negotiating and resolving assigned General Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim … more
- Travelers Insurance Company (Morristown, NJ)
- …law in conjunction with Claim counsel and First Party Medical claim professional, if necessary. Proactively manage ongoing litigation/arbitration through ... **What Is the Opportunity?** This position handles First Party Medical Litigation or Arbitration claims from the...facts necessary to determine defensibility and potential exposure. Prompt review of claim file and handling procedures… more
- Travelers Insurance Company (St. Paul, MN)
- …case resolution. + Review , approve and issue accurate and timely indemnity, medical and expense payments for lifetime/long-term claims . Determine Value of ... 1 **What Is the Opportunity?** Under moderate supervision, manage Workers' Compensation Claims with: Stable Lifetime Indemnity and/or Medical Benefits where the… more
- Robert Half Accountemps (Novi, MI)
- …scheduled incoming claims documents for timeliness, as applicable (eg medical records; initial claim documents including disability applications and/or ... all aspects of operational support for the Disability Management Services disability claim review process, including any administrative and/or clerical tasks as… more
- Travelers Insurance Company (St. Paul, MN)
- …direct supervision, this position is responsible for: Reviewing/evaluating, approving and processing Medical Only claims with: No lost time beyond statutory ... guidelines, medical position statements, etc.). + Coordinate medical treatment as appropriate: + Review , approve...impacted parties. + Identify the need for and engage nurse resource for utilization review when appropriate.… more
- Lincoln Financial Group (Boise, ID)
- …for conducting initial and ongoing interviews with claimants, obtaining and reviewing medical records, and making timely and ethical claim determinations. You'll ... are excited to bring on a highly motivated **Group Claims Specialist** to support our ever-growing claims ...managers, and consulting physicians to make appropriate and timely claim determinations. + Reviewing complex medical records… more
- Lincoln Financial Group (Columbus, OH)
- …for conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You'll ... professionals through phone and e-mail to gather information regarding Short Term Disability Claims , Family Medical Leaves, and state benefits when applicable. +… more
- Elevance Health (Harrisburg, PA)
- …send you a check, or ask you for payment as part of consideration for employment. **Clinical Review Nurse I (US)** + Job Family: MED > Licensed Nurse + Type: ... + Maine, South Portland + Wisconsin, Waukesha **Description** **Clinical Review Nurse I** National Government Services is... Reviewer I** is responsible for reviewing and making medical determinations as to whether a claim … 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
- The Arora Group (Bethesda, MD)
- Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in Bethesda, ... required on Federal holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW : + Initiate,...clinical information and may also provide education on the medical review process. + The Contractor performing… 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
- Vighter Medical Group (Weslaco, TX)
- …appointment consists of: (1) a review of the veterans disability claim (Disability Benefit Questionnaire) and medical history prior to the appointment, ... Nurse Practitioner PT- Weslaco, TX Job Details Job...non-treatment psychological assessment related to the veterans service-connected disability claims . Common reasons for disability claims include:… 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 ... clients and the people they serve. **Responsibilities** **Position Duties:** + Manage medical Prior Authorizations (PA) as assigned by the PA supervisor, utilizing… 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 ... This includes approval determinations and appropriate exceptions, coordinating with Medical Directors on denials, completing inpatient level of care reviews,… more
- Commonwealth of Pennsylvania (PA)
- …I have professional experience performing this Work Behavior as a charge nurse , head nurse , utilization review nurse , quality assurance nurse , or an ... + A conditional offer of employment will require a medical examination. + This position falls under the provisions...Work Behavior as a charge nurse , head nurse , utilization review nurse , quality… more
- Ascension Health (Pensacola, FL)
- …cases. + Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. + ... health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests within assigned… more
- Blue KC (MO)
- …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
- Ascension Health (Wichita, KS)
- …cases. + Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. + ... **Details** + **Department:** Utilization Review - Behavior Health + **Schedule:** PRN, Day Shift, 8 hr shift, Rotating Weekends and Holidays + **Hospital:**… more
- Ascension Health (Southfield, MI)
- …cases. + Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. + ... health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests within assigned… more