- Berkshire Hathaway Homestate Companies (Omaha, NE)
- … claims staff, and attorneys. Act as a medical resource in regards to utilization review to Claims Support Nurse , Bill Review , and Claims ... Company staff, including the claims staff, medical bill review , claims support nurse , special investigations, legal, liens, the call center, and… more
- Berkshire Hathaway Homestate Companies (Walnut Creek, CA)
- …Reasonable caseload with in-house Medical Management support (UR, Med Bill Review , Resource Nurses); In-house Claims Assistant support Modern Office Setting ... Medical Management, Special Investigations, Client Services, Underwriting, and Claims Legal. Communicates effectively with individuals outside the company,… 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 ... 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 ... Identifies questionable cases and refers to superior or a medical director for review .' Required experience: Must...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)
- …Interdisciplinary Treatment Team to ensure that all team members are aware of all medical conditions and care. 8. Review reports daily to ensure timely, ... and regulatory standards. 6. Participate with nursing management to review , update and develop policies and procedures for clinical...investigations and reviews. SUPERVISES : Nurse Educators Nurse Case Managers (NCM) Medical Case Manager… more
- Elevance Health (Richmond, VA)
- …and abuse prevention and control. Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions ... End Date: 2025-07-31 Position Title: Clinical Fraud Investigator II - Registered Nurse and CPC - Carelon Payment Integrity SIU Job Description: Clinical Fraud… 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 ... prior 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)
- …for utilization management functions. This includes but is not limited to review and authorization of services, utilization of medical policy, utilization ... 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
- 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
- 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, ... Chief Medical Officer. Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the… more
- UHS (Bradenton, FL)
- …rewarding work environment Competitive Compensation & Generous Paid Time Off Excellent Medical , Dental, Vision and Prescription Drug Plans 401(K) with company match ... 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… more
- Sutter Health (Modesto, CA)
- …quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and ... experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely progression and… more
- Marriott (Bethesda, MD)
- …and procedures. * Coordinate medical management aspects of file handling with the Nurse CARE Manager and Nurse Review Specialist. * Prepare case ... Representative is responsible for the administration and disposition of medical only (MO) workers compensation (WC) claims ....reports, provide for fee schedule or other appropriate bill review , and process for payment in accord with Marriott… more
- The County of Los Angeles (Los Angeles, CA)
- …REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse * or Medical Service Coordinator, CCS.** -OR- OPTION ... UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333)...needed, and to make recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review… more
- State of Connecticut, Department of Administrative Services (New Haven, 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...third-party administrator files to oversee contractor handling; + May review medical records of various health care… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …software for financial care activities including eligibility verifications, pre-authorizations, medical necessity, review /updating of patient accounts, etc. * ... *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-… 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
- US Tech Solutions (Columbia, SC)
- …Utilizes available resources to promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for ... appeals requests using Medicare criteria. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by… 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...or clinical summary as appropriate, incorporating supportive documentation. (ie medical criteria, state regulations, etc). + Assist in clearing… more
