- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …and eliminating fraud, waste and abuse. Responsibilities: + Perform the clinical review in Standard Claims Processing System files (eg, medical records, ... of medical terminology and experience in the analysis and processing of claims , utilization review , quality assurance procedures, payment methodologies and Part… more
- Zelis (Plano, TX)
- Position Overview : The Manager, DRG Validation of the Expert Claims Review (ECR) department is responsible for daily operations and team management of the ... and department procedures + Serve as the Subject Matter Expert on DRG validation to team members and other...Zelis standards regarding privacy Skills, Knowledge, and Experience: + Registered Nurse licensure required + Inpatient Coding… more
- Ankura (PA)
- …Qualifications: + Bachelor's degree in nursing from an accredited college/university + Current Registered Nurse license + Clinical experience in a variety of ... on a wide variety of legal and regulatory matters. Our practitioners provide expert witness testimony on commercial disputes involving payers and providers, as well… more
- Commonwealth Care Alliance (Boston, MA)
- …of the Business Solutions Team, acts as the foremost IT subject-matter- expert for the product(s) supported, understanding the complete technical stack, including ... and streamline business processes. + Function as the technical subject matter expert for all applications in the corresponding business vertical(s). + Oversee the… more
- CareFirst (Baltimore, MD)
- …in addition to the required work experience. **Licenses/Certifications Upon Hire Required:** + RN - Registered Nurse - State Licensure And/or Compact ... the overall Corporate Strategic Plan through direction of the Clinical Medical Claims Review , Medical Underwriting, Medical Policy, Clinical Appeals and Analysis… more
- State of Nevada (NV)
- …the following requirements: Education and Experience (Minimum Qualifications) Licensure as a Registered Nurse and two years of professional experience providing ... City or Reno NV. The Health Care Coordinator (HCC) Nurse position serves as the clinical expert ...required of the selected applicant. Professional licensure as a registered nurse or certification in a medical… more
- Houston Methodist (Nassau Bay, TX)
- …performance that demonstrates progressive leadership abilities **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure ... specifications. + Manages utilization management (UM) programs including Medical Claims Review , Precertification and Reconsiderations and Appeals....and/or Compact State Licensure within 60 days **OR** + RN -Temp - Registered Nurse -… more
- Public Consulting Group (Cedar Rapids, IA)
- …+ Ability to successfully monitor and ensure the quality of data analytic and clinical review activities. + Knowledge of claims and medical record review ... for coordinating program integrity-related reviews with the medical necessity review team responsible for conducting medical necessity reviews, ensuring services… more
- Houston Methodist (The Woodlands, TX)
- …assigned patient population, under the direct supervision of a Physician, APP and/or Registered Nurse . This position oversees appropriate scope of practice, (ie ... of patient care and services, while functioning as an expert and demonstrating highly competent knowledge in the more...the clinic under the direct supervision of a Physician, Registered Nurse , or clinic leadership procedures, using… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …services **Required Licensure and Certifications:** Current unrestricted licensure as a Registered Nurse in the state of Washington National certification ... you will find the safest and highest quality of care provided by our expert , compassionate medical care team at 11 hospitals and nearly 300 sites throughout the… more
- Hackensack Meridian Health (Hackensack, NJ)
- …or Interqual. **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. **Licenses and Certifications Preferred:** + ... Nurse Specialist** will be responsible for the timely review and submission of appeals for denied managed care...of appeals for denied managed care inpatient and/or outpatient claims to insurance companies for reconsideration of denials and/or… more
- NHS Management, LLC (Fayetteville, AR)
- …with company match + Paid Holidays and Paid Vacation Requirements + Must be a Registered Nurse in good standing + Previous experience in a supervisory capacity ... way. We are in search of a qualified Regional Nurse Consultant: The Regional Nurse Consultant will... Consultant will be responsible for the dissemination of expert advice and oversight to facility management personnel and… more
- Carnival Cruise Line (Miami, FL)
- … claims experience required. **Knowledge, Skills and Abilities:** + Expert -level writing skills. Strong organizational skills and the ability to prioritize ... a general knowledge of organizational insurance programs and resources and managing claims against the organization; interfacing with legal defense counsel and … more
- Trinity Health (Syracuse, NY)
- …or workplace investigations, injury case management and/or OSHA recordkeeping.** ** RN preferred** **SPECIAL EQUIPMENT, SKILLS, OR OTHER REQUIREMENTS:** **Strong ... **Management** **Responsibilities:** **The Colleague Safety Specialist is the subject matter expert for the THNY colleague injury loss control programs and is… more
- Trinity Health (Albany, NY)
- …safety or workplace investigations, injury case management and/or OSHA recordkeeping. + RN preferred + Certified CPPS or equivalent preferred. Required within 2 ... Management **Responsibilities:** + The Colleague Safety Specialist is the subject matter expert for the THNY colleague injury loss control programs and is… more
- HCA Healthcare (Nashville, TN)
- …apply! **Job Summary and Qualifications** The Revenue Cycle Operations Quality Review Specialist CODER performs internal quality assessment reviews on processes ... audit including coding criteria and guidelines in clinical denials and insurance claims . Quality reviews are communicated to the Parallon Revenue Cycle Operations… more
- Commonwealth Care Alliance (Boston, MA)
- …Yes **What You'll Be Doing:** + Function as the IT subject matter expert for Ancillary & Pharmacy integrations, platforms, and tools. + Collaborate with IT ... and deliver business outcomes. + Consult with business unit's and review IT usage, services, technology, and department specific projects. Identify, forecast… more