- US Tech Solutions, Inc. (Columbia, SC)
- …utilization practices. . May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim ... I would love to have someone with prior insurance/utilization review experience, but I know that is not very...a typical day would like in this role: The nurse would work remotely from their home reviewing authorization… more
- JobsRUs (Waxahachie, TX)
- JobsRUs.comis seeking to hire a Occupational Health Nurse for our client in Waxahachie, TX! Benefits Available!Weekly Pay! $40.00/Hour Shift details:6:00AM - ... in Microsoft Office Experience working with Corey a plusThe Occupational Health Nurse is responsible for promoting the health and well-being of Client employeesat… more
- Spectraforce Technologies Inc (Atlanta, GA)
- …the HEDIS Clinical Measurement and Improvement Lead and other Company personnel to review medical records. The HEDIS Nurse Abstractor will abstract pertinent ... Job Title: HEDIS Nurse Abstractor (100% REMOTE) Duration: 3-4 Months Job...specified database to support HEDIS reporting. Daily Activities include review and abstraction of medical records, electronic data entry… more
- Staffing Now (Norfolk, VA)
- …outpatient precertification, prior authorization, and post service requests.Refers cases requiring clinical review to a Nurse reviewer .Responsible for the ... $17/hour Responsible for coordinating cases for precertification and prior authorization review . Primary duties may includes, but are not limited:Managing incoming… more
- Staffing Now (Nashville, TN)
- …outpatient precertification, prior authorization, and post service requests. Refers cases requiring clinical review to a Nurse reviewer . Responsible for the ... openings! Responsible for coordinating cases for precertification and prior authorization review . Primary duties may includes, but are not limited: Managing incoming… more
- Cambia Health Solutions, Inc (Portland, OR)
- …member of the Clinical Audit team, the Payment Integrity RN (I) conducts post service review of claims in prepayment, post payment or audit capacity to ensure ... appropriate clinical review , reimbursement of claims and accuracy of...years (or full time equivalent) of direct clinical careRegister Nurse (RN) license (must have a current unrestricted RN… more
- Accounting Now (Tampa, FL)
- …management and appeals follow-upThe individual is responsible for conducting a comprehensive review of the insurance denial and working with the Clinical Denials ... to compile appropriate documentation and medical records to submit appeals or corrected claims in a timely mannerThis position applies prior knowledge of denials to… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …Health and Workers' Compensation and other Casualty clients. The Workers' Compensation Nurse Case Reviewer collaborates with medical care providers, employers, ... and the evaluation of coverage under the Plan. The Nurse Case Reviewer reports to the Casualty...+ Collaborates with workers' compensation patients, employers, providers, and claims adjusters to coordinate medical and disability services for… more
- Zelis (Morristown, NJ)
- Position Overview: The Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical ... care organization or provider preferred. + 2+ years of auditing or performing claims review in specialty pharmacy claims or specialty drugs + Strong… more
- ManpowerGroup (Columbia, SC)
- **Job Title: Medical Claims Reviewer ** **Pay Rate:23/Hr (REMOTE opportunity after training)** **Duration:3+ Months on W2** **Location:4101 Percival Road Columbia ... the state of hire. **Job Description:** As a Medical Claims Reviewer /Utilization Management Specialist, you will be...Ensure thorough documentation of each determination for utilization or claims review . + Review first-level… more
- Publix (Lakeland, FL)
- …workers' compensation claims function including claims handling, nurse case management, medical bill review , vocational rehab and support ... Vice President of Risk Management. **Key Responsibilities:** + **Cost Control & Claims Management:** Oversee and manage all aspects of workers' compensation … more
- City of New York (New York, NY)
- …The Division of Liens and Recovery Casualty Program places liens and assert claims against the personal injury lawsuit settlements of past or present recipients of ... of Nurses to function as a Complex Medical Case Reviewer , who will: - Conduct medical reviews and analyses..., who will: - Conduct medical reviews and analyses claims to calculate injury related Medicaid liens pursuant to… more
- Zelis (TX)
- Position Overview: The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG reviews ... clinical criteria plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA… more
- M. C. Dean (Vienna, VA)
- …decisions about liability/compensability, evaluating losses, managing relationship with the carrier claims adjuster, nurse case managers and stakeholders within ... and damages. + Assesses policy coverage for potential GAPS in coverage; review the established reserve requirements, identified claims for subrogation and/or… more
- Defense Health Agency (Honolulu, HI)
- …and illnesses. Works with the Fort Shafter Federal Employee Compensation Act (FECA) Claims Administrator to identify cases that require review , screens all FECA ... Program Administrator (ICPA) , Office of the Worker's Compensation Program (OWCP) claims examiner, OWCP nurse case manager, lawyer, and union representatives.… more
- Metropolitan Council (St. Paul, MN)
- …leave. + Investigate and pursue subrogation, as appropriate. + Participate in bi-annual claims meetings with internal departments. + Review medical, legal, and ... Workers' Compensation Claims Representative II - REPOST Print (https://www.governmentjobs.com/careers/metrocouncil/jobs/newprint/4511198) Apply...Benefits + Questions WHO WE ARE We will NOT review resumes or cover letters for this position, so… more
- Lincoln Financial Group (Columbus, OH)
- …a Glance** We are excited to bring on a highly motivated Long-Term Disability (LTD) Claims Specialist to our claims organization. **What you'll be doing** As an ... LTD Claims Specialist, you will manage a workload of Long-Term...benefits when applicable. * Collaborating with fellow case managers, nurse case managers, vocational case managers, and consulting physicians… more
- Lincoln Financial Group (Columbus, OH)
- …Role at a Glance** We are excited to bring on a highly motivated **Group Claims Specialist** to support our ever-growing claims organization in a work from home ... to support our west coast employer groups. _Background details_ As a Group Claims Specialist, you will support our Short Term Disability or Integrated Absence teams.… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *SUMMARY:* We are currently seeking an*RCM Representative Senior*to join our*Third-Party Claims - HB & PB *team. This full-time role will primarily work remotely ... 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
- 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
