• Nurse Audit Senior

    Elevance Health (Norfolk, VA)
    …+ Travels to worksite and other locations as necessary. + BA/BS preferred. + Medical claims review with prior health care fraud audit/investigation ... you for payment as part of consideration for employment. ** Nurse Audit Senior** + Job Family: Medical ...and DRG assignment by health care providers through prepayment claims review , post payment auditing, and provider… more
    Elevance Health (03/09/24)
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  • Program Integrity & Medical Necessity…

    Public Consulting Group (Council Bluffs, IA)
    …ensure the quality of data analytic and clinical review activities. + Knowledge of claims and medical record review data across provider service types. + ... **Responsibilities** + Responsible for coordinating program integrity-related reviews with the medical necessity review team responsible for conducting … more
    Public Consulting Group (02/14/24)
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  • Manager Case Manager & Social Services - Full Time…

    Houston Methodist (Houston, TX)
    …to department specifications. + Manages utilization management (UM) programs including Medical Claims Review , Precertification and Reconsiderations and ... efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and exceed...progressive leadership abilities **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
    Houston Methodist (02/06/24)
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  • Registered Nurse ( RN ) - PFS…

    University of Virginia (Charlottesville, VA)
    …policies and procedures is required. + Utilizes clinical knowledge, payor contracts, medical review policies, supporting research, and any other relevant ... procedures and the use of independent judgment in a medical setting. The purpose is to achieve the goals...also be considered. Licensure: Licensed to practice as a Registered Nurse in the Commonwealth of Virginia… more
    University of Virginia (03/22/24)
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  • Registered Nurse ( RN

    Beth Israel Lahey Health (Winchester, MA)
    …Occupational Health Nurse preferred. **LICENSE, CERTIFICATION REQUIRED:** Massachusetts Registered Nurse license. Certification as an Occupational Health ... Bachelor's degree in Nursing. Bachelor's degree in Nursing preferred. 2. At least three years work experience as a medical or surgical staff nurse . 3. Certified… more
    Beth Israel Lahey Health (01/25/24)
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  • Registered Nurse - Authorization…

    Public Consulting Group (Augusta, ME)
    **Overview** ** Registered Nurse - Health Services Consultant** **Authorization Review - Office of MaineCare Services in Augusta, ME** This role will be ... + Ability to develop and implement corrective actions. **Minimum Qualifications:** + Registered Nurse and three (3) years of progressively responsible experience… more
    Public Consulting Group (02/16/24)
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  • Registered Nurse I, Sheriff…

    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...vaccination against COVID-19 or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates… more
    The County of Los Angeles (03/28/24)
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  • Registered Nurse Advocate- Remote…

    CNO Financial Group (Carmel, IN)
    …need:** + Bachelor's degree in nursing (BSN) from an accredited institution + Active registered nurse ( RN ) license in [state/country of employment]. + Three ... Optavise, a CNO Financial Group Company is seeking a Registered Nurse Advocate to take on a...address them effectively. + Evaluate prior authorization requests for medical necessity and review medical more
    CNO Financial Group (03/26/24)
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  • Registered Nurse - Risk Management…

    Veterans Affairs, Veterans Health Administration (Chicago, IL)
    Summary The Jesse Brown VA Medical Center has an opening for a Registered Nurse - Risk Management Specialist in the Quality and Patient Safety Service ... and mitigating, enterprise risk throughout the organization. Responsibilities The Registered Nurse ( RN ) - Risk...as well as facilitating Peer Reviews and the Peer Review Committee for the Medical Center. He/she… more
    Veterans Affairs, Veterans Health Administration (03/26/24)
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  • Registered Nurse - Risk…

    Veterans Affairs, Veterans Health Administration (New Orleans, LA)
    Summary The Peer Review /Risk Management RN oversees the entire Risk Management Program. Their role involves evaluating and improving the appropriateness and ... monitoring of internal and external reviews. Responsibilities The Peer Review /Risk Management RN is organizationally responsible to...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
    Veterans Affairs, Veterans Health Administration (03/21/24)
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  • Registered Nurse - Emergency…

    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...the Emergency Department (ED) for avoidable reasons identified through claims data and ED daily census. You will educate… more
    Public Consulting Group (02/14/24)
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  • Care Manager, Registered Nurse

    Sutter Health (Auburn, CA)
    …or Health related field or equivalent education/experience **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California Upon Hire **TYPICAL ... position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to...services, third party payers and review agencies, claims and finance departments, Medical Directors, and… more
    Sutter Health (03/22/24)
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  • Care Manager II, Registered Nurse

    Sutter Health (Burlingame, CA)
    …: **EDUCATION:** Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** RN - Registered Nurse of California Upon Hire CCM certification ... position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to...services, third party payers and review agencies, claims and finance departments, Medical Directors, and… more
    Sutter Health (01/22/24)
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  • Utilization Review Nurse

    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 ... for medical necessity reviews. + Manage the review of medical claims disputes,...and offerings. Education/Experience: + Unrestricted state license as a Registered Nurse required; BSN preferred. + 3+… more
    Martin's Point Health Care (03/20/24)
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  • Utilization Review Nurse (40 Hour)

    State of Connecticut, Department of Administrative Services (Hartford, CT)
    medical treatment facility, in rehabilitative or occupational nursing or providing medical review of insurance claims . MINIMUM QUALIFICATIONS - ... Utilization Review Nurse (40 Hour) Office/On-Site Recruitment...application online (expand the 'Public Health Practitioners' grouping, select ' Registered Nurse ' and then 'Start'; + Request… more
    State of Connecticut, Department of Administrative Services (03/15/24)
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  • Risk Quality Coordinator

    HCA Healthcare (Port St. Lucie, FL)
    …Manager. + Works with claims counsel as assigned in assisting with discovery on claims . + Provides medical record review that is thorough and accurate ... Staff Committees and maintenance of the Physician QA Profiles; medical staff performance chart review , data retrieval,...the Risk Manager in the timely identification of potential claims through incident review and discussing occurrence… more
    HCA Healthcare (03/07/24)
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  • RN Utilization Management - Per Diem

    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...Health System process improvement. + Denials Adjudication + Facilitate review of rejected medical claims more
    Guthrie (03/12/24)
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  • Utilization Management Nurse Specialist LVN…

    LA Care Health Plan (Los Angeles, CA)
    …and Physician Advisor on case reviews for pre-service, concurrent, post-service and retrospective claims medical review . Monitors and oversees the collection ... workplace environment. Perform prospective, concurrent, post-service and retrospective claim medical review processes. Utilizing considerable clinical judgement,… more
    LA Care Health Plan (03/12/24)
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  • Employee Health RN PRN

    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** offers a total rewards package that supports... Center! **Job Summary and Qualifications** The **Employee Health Registered Nurse ** is responsible for delivering high… more
    HCA Healthcare (03/20/24)
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  • Insurance and Claims Specialist PACE…

    HCA Healthcare (Asheville, NC)
    …position is responsible for ensuring timely and accurate processing and payment of claims by the Third-Party Administrator through competent review of claims ... where diversity and inclusion thrive? Submit your application for our Insurance and Claims Specialist (Program of All Inclusive Care for the Elderly) Program opening… more
    HCA Healthcare (02/22/24)
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