- Berkshire Hathaway Homestate Companies (Omaha, NE)
- …and attorneys. Act as a medical resource in regards to utilization review to Claims Support Nurse , Bill Review, and Claims department. Foster a positive ... with other Company staff, including the claims staff, medical bill review, claims support nurse , special investigations, legal, liens, the call… more
- PMA Companies (Baltimore, MD)
- As a member of our claims team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more ... In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with legal statues, policy provisions,… more
- Berkshire Hathaway Homestate Companies (Walnut Creek, CA)
- …Medical Management, Special Investigations, Client Services, Underwriting, and Claims Legal. Communicates effectively with individuals outside the company, ... results, and are willing to accept ownership for their work product. This Claims Professional is responsible for the management of a caseload of workers compensation… more
- Rula Health (Charlotte, NC)
- …work for everyone. Minimum qualifications: 1+ years as a psychiatric nurse practitioner with experience with mental health assessment, diagnosis, triage, managing ... state law Board certified as a Psychiatric Mental Health Nurse Practitioner (PMHNP) by the American Nurses Credentialing Center...two weeks with no need to worry about unpaid claims No-show protection: Rula pays you 100% of your… more
- Greenlife Healthcare Staffing (New York, NY)
- …NYS Registered Nurse license Experience : At least 2 years in utilization review, claims , medical review, fraud investigation , or monitoring ; OR 3 years of ... Registered Nurse - Nursing Home Surveyor / Complaint Investigator...the Role GreenLife Healthcare Staffing is seeking a Registered Nurse (RN) to serve as a Nursing Home Surveyor/Complaint… more
- Constructive Partnerships Unlimited (New York, NY)
- …in all corporate compliance investigations and reviews. SUPERVISES : Nurse Educators Nurse Case Managers (NCM) Medical Case Manager Counselors (MCMC) ... position is a combined role that encompasses the responsibilities of both the Nurse Administrator and Coordinator of Nursing Education and reports directly to the… more
- Elevance Health (Little Rock, AR)
- Anticipated End Date: 2025-08-25 Position Title: Nurse Case Manager I (OB/NICU Experience Preferred) Job Description: The Nurse Case Manager I is responsible for ... of the care management plan and modifies as necessary. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment… more
- Strategic Staffing Solutions (Burlington, VT)
- …with one of our largest clients located in Vermont! Title: Clinical Review Registered Nurse Duration : W2 Contract Location: Remote in Vermont Duration: 3 Month - ... care through the performance of clinical reviews. Reviews requests against standardized medical necessity and appropriateness criteria for an initial and a continued… more
- Elevance Health (Richmond, VA)
- …for fraud and abuse prevention and control. Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related ... End Date: 2025-07-31 Position Title: Clinical Fraud Investigator II - Registered Nurse and CPC - Carelon Payment Integrity SIU Job Description: Clinical Fraud… more
- Erie County, NY (Buffalo, NY)
- …IN THIS EXAMINATION. There is one anticipated vacancy at the Erie County Medical Center Corporation. Examples of Duties A Nurse Practitioner- Dept. of ... Type: Full Time Job Number: 42365010 Department: ERIE COUNTY MEDICAL CENTER (ECMC) Opening Date: 06/25/2025 Closing Date: 7/30/2025...either: A) One (1) year of experience as a Nurse Practitioner in the certified specialty area; or: B)… more
- Critical Nurse Staffing (Harriman, TN)
- Registered Nurse - RN Full-Time & Part-Time Hours Available Private duty caregiver, Benefits at 30+ hrs/week Pay Rate: $40.00 - $45.00 per hour Sign On Bonus: $5,000 ... Veterans of the United States Armed Services, Workers Compensation Claims , and former energy workers who want to remain...eligible at 30+ hours per week Paid Time Off Medical , dental, vision (full-time) starting the 1st of the… more
- Critical Nurse Staffing (Albuquerque, NM)
- Job Type Full-time, Part-time Description Registered Nurse - RN Private duty caregiver Full-Time / part-Time Benefits at 30+ hrs./week|$35.00-$45.00 Come work for ... Veterans of the United States Armed Services, Workers Compensation Claims , and former energy workers who want to remain...eligible at 30+ hours per week Paid Time Off Medical , dental, vision, and 401K Supplemental insurance available One-on-one… more
- Regal Medical Group, Inc. (Northridge, CA)
- … claims review nurse team (nurses/coders), who work with the claims department to assist in making medical necessity determinations of submitted ... authorization nurse case managers and support staff (coordinators), professional claims review nurses and UM compliance staff to promote quality, cost… more
- McLaren Health Care Corporation (Indianapolis, IN)
- …is not limited to review and authorization of services, utilization of medical policy, utilization of standard screening techniques, and utilization of behavioral ... identification of high risk, and under and overuse of services. Collaborates with Medical Director and senior management on complex cases and special projects. This… more
- University of Southern California (Pasadena, CA)
- …by the physician as needed. Reviews and codes charge slips, submits insurance claims . Returns patient phone calls. Performs various office and clerical duties. Must ... as needed. Reviews and codes charge slips, submits insurance claims . Returns patient phone calls. Performs various office and...and HMO requests. Relays disability status to adjusters and nurse case managers. Returns patient phone calls in a… more
- Sinceri Senior Living (Nashville, TN)
- …to protect our organization and residents through proactive risk assessment, claims management, and quality improvement initiatives. The position requires a ... Registered Nurse or Licensed Practical Nurse with strong...teams, insurance carriers, and community staff. Essential Job Functions: Claims Management & Insurance Coordination Submit and manage … more
- Avera Health (Sioux Falls, SD)
- …documents and processes worker's compensation. Coordinates with employees, department leadership, claims adjusters and medical providers to assure continuity of ... Health assumes responsibility for the new hire process, immunization programs, medical surveillance, Workman's Compensation, Drug and Alcohol programs, ADA and FMLA… more
- IntellaTriage (Brentwood, TN)
- …nurses are able to be at ease knowing their patients are in good hands. Our nurse triage services are in high demand, exceeding our growth goals every year for the ... has transformed from quality small business to the leading provider of after-hours nurse triage in the hospice and home health markets. Our nursing team has… more
- The Travelers Indemnity Company (Morristown, NJ)
- …internal and/or external resources for specific activities required to effectively evaluate claims , such as Subrogation, Risk Control, nurse consultants, and ... resolving assigned Specialty Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim life cycle (customer… more
- Molina Healthcare (Long Beach, CA)
- …reviews of claims and appeals and resolves grievances related to medical quality of care. Attends or chairs committees as required such as Credentialing, ... Summary Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and… more
