- Berkshire Hathaway Homestate Companies (Omaha, NE)
- …workers, claims staff, and attorneys. Act as a medical resource in regards to utilization review to Claims Support Nurse , Bill Review , and Claims ... with other Company staff, including the claims staff, medical bill review , claims support nurse , special investigations, legal, liens, the call center,… more
- Regal Medical Group, Inc. (Northridge, CA)
- …referral authorization issues, as well as care coordination issues. Oversight of the professional claims review nurse team (nurses/coders), who work with the ... nurse case managers and support staff (coordinators), professional claims review nurses and UM compliance staff to promote quality, cost effectiveness… more
- Berkshire Hathaway Homestate Companies (Walnut Creek, CA)
- …week) Reasonable caseload with in-house Medical Management support (UR, Med Bill Review , Resource Nurses); In-house Claims Assistant support Modern Office ... 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
- Greenlife Healthcare Staffing (New York, NY)
- …Active NYS Registered Nurse license Experience : At least 2 years in utilization review , claims , medical review , fraud investigation , or monitoring ; OR ... 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
- Strategic Staffing Solutions (Burlington, VT)
- …opportunity with one of our largest clients located in Vermont! Title: Clinical Review Registered Nurse Duration : W2 Contract Location: Remote in Vermont ... and refers to superior or a medical director for review .' Required experience: Must have 5+ years of clinical/hospital...service delivery and utilization and cost data. Assist the claims payer in accurate adjudication of care management approved… more
- Constructive Partnerships Unlimited (New York, NY)
- …position is a combined role that encompasses the responsibilities of both the Nurse Administrator and Coordinator of Nursing Education and reports directly to the ... Vice President and Assistant Vice President. As Nurse Administrator, you are responsible for ensuring that all...and regulatory standards. 6. Participate with nursing management to review , update and develop policies and procedures for clinical… more
- Elevance Health (Richmond, VA)
- …guidelines and to identify opportunities for fraud and abuse prevention and control. Review and conducts analysis of claims and medical records prior to ... 2025-07-31 Position Title: Clinical Fraud Investigator II - Registered Nurse and CPC - Carelon Payment Integrity SIU Job...SIU Job Description: Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU Location:… more
- McLaren Health Care Corporation (Indianapolis, IN)
- …for utilization management functions. This includes but is not limited to review and authorization of services, utilization of medical policy, utilization of ... of HMO, PPO, TPA, PHO and Managed Care functions including understanding of claims administration, including CPT-4 codes, revenue codes, HCPCS codes, DRGs, etc. Two… more
- Sinceri Senior Living (Nashville, TN)
- … review Document lessons learned and best practices from claims and litigation Ensure compliance with regulatory reporting requirements Maintain confidential ... to protect our organization and residents through proactive risk assessment, claims management, and quality improvement initiatives. The position requires a… 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
- Methodist Family Health (Jonesboro, AR)
- Registered nurses report directly to the nurse supervisor they work collaboratively with the health care team to provide holistic care to the acute or transitional ... of an Accredited School of Nursing. Current Arkansas Registered Nurse license. Experience with adolescents and children in a...and a computer to communicate through written means, to review information and enter/retrieve data, to see and read… more
- Molina Healthcare (Long Beach, CA)
- …by the Chief Medical Officer. Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... issues, focused reviews and recommends corrective actions. Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of… more
- UHS (Bradenton, FL)
- …part of a large network of peer co-workers that routinely exchange ideas and review current topics within the industry. Having the opportunity to grow, learn, and ... treatment setting. Three (3) years' management experience preferred. Preferred current Registered Nurse License by Board of Nurse Examiners for the State… more
- Sutter Health (Modesto, CA)
- …team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and ... Graduate of an accredited school of nursing CERTIFICATION & LICENSURE: RN-Registered Nurse of California Upon Hire TYPICAL EXPERIENCE: 2 years recent relevant… more
- Marriott (Bethesda, MD)
- …policies and procedures. * Coordinate medical management aspects of file handling with the Nurse CARE Manager and Nurse Review Specialist. * Prepare case ... Time **Located Remotely?** N **Position Type** Management **JOB SUMMARY** The Claims Representative is responsible for the administration and disposition of medical… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE ... regarding County employee benefits. DHS is seeking dedicated Utilization Review Nurse Supervisors to join our team....steps to view correspondence, and we will not consider claims for missing notices to be a valid reason… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *SUMMARY:* We are currently seeking a*RCM Representative Senior*to join our Third-Party Claims -HB&PB team. This full-time role will primarily work remotely (Days, M- ... service and timely response to questions and issues related to benefits, billing, claims , payments, etc. * Answers questions (by phone and in-person) and provides… more
- State of Connecticut, Department of Administrative Services (New Haven, CT)
- Utilization Review Nurse (40 Hour) Office/On-Site Recruitment # 250715-5612FP-001 Location New Haven, CT Date Opened 7/22/2025 12:00:00 AM Salary $78,480 - ... is seeking a highly motivated and compassionate U tilization Review Nurse (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5612FP&R1=&R3=) to join our team!… 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 Center, one...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- UPMC (Pittsburgh, PA)
- …looking to grow your career? UPMC is hiring a full-time Revenue Cycle Clinical Review Nurse . This position works Monday through Friday during daylight hours. ... eligible to work from home. The Revenue Cycle Clinical Review Nurse provides support to the local...medical criteria, state regulations, etc). + Assist in clearing claims for billing as indicated. + Maintain current knowledge… more
