- Frontera Search Partners (North Platte, NE)
- …but not required* State License must be in good standingExaminations begin with a review of the Veterans medical history, which includes an abstract that ... to let you know about an opportunity for a Nurse Practitioner to give back to Americas heroes and...highlights portions of the history applicable to the Veterans claim .Our providers are proud to deliver high quality, convenient… more
- Accounting Now (Tampa, FL)
- …Denials Nurse , Coding Denials Specialists, and Leadership in high-dollar claim denial review .Monitors for denial trends, works collaboratively with the ... Clinical Denials Nurses and Coding Denials Specialists to compile appropriate documentation and medical records to submit appeals or corrected claims in a timely… more
- 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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …the claims according to appropriate guidelines. This position requires strong clinical and medical coding skills to review claims for medical ... Nurse Reviewer is responsible for reviewing claims , validating coding and medical necessity of...with Provider Service, Claims , Network Management, Physician Review , and Medical and Payment Policy teams.… 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
- 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:** ... Compensation Compliance Supervisor and Workers Compensation Compliance Manager, the Claims Review Specialist will assist in the...to be made by the TPA + Effectively monitors medical and disability claim authorizations and payments… 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
- Access Dubuque (Dubuque, IA)
- …reviews and analyzes management reports and takes appropriate action. + Performs quality review on claims in compliance with audit requirements, service contract ... authority of the individual examiner. + Monitors third party claims ; maintains periodical review of litigated ...Medical Group Patient Service Representative (PRN) Grand River Medical Group Biologic Nurse (RN/LPN) Grand River… more
- Banner Health (AZ)
- …necessary information to consultant/expert for review . Collaborates with Claims Directors regarding disposition of claim . Drafts appropriate Settlement ... focused on enhancing processes and maximizing efficiency with the review and management of claims and litigation...management of claims and litigation matters. Paralegal, claims adjustor experience, medical litigation experience is… 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
- Access Dubuque (Dubuque, IA)
- …FUNCTIONS and RESPONSIBILITIES** + Processes auto property damage and lower level injury claims ; assesses damage, makes payments, and ensures claim files are ... Claims Representative - Auto **Sedgwick** 1 Positions ID:...Medical Group Patient Service Representative (PRN) Grand River Medical Group Biologic Nurse (RN/LPN) Grand River… 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 ... through phone and e-mail to gather information regarding the Short Term Disability claim . + Collaborating with fellow case managers, nurse case managers and… more
- Elevance Health (East Syracuse, NY)
- **Clinical Review Nurse I - Medicare Part B**... Reviewer I** is responsible for reviewing and making medical determinations as to whether a claim meets ... and reasonableness of the items supplied in a valid claim through the use of medical policy...highly desired but not required. + Prior experience with claim review of Medicare helpful. + Proficient… 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 (El Paso, TX)
- Nurse Practitioner PT- El Paso, TX Job Details...(1) a review of the veterans disability claim (Disability Benefit Questionnaire) and medical history ... None Job Shift Day Job Category Health Care Description Position Description: Nurse Practitioner to perform compensation and pension examinations as a Vighter… 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
