- TulaRay (Harrisburg, PA)
- …Minimum Qualifications: Possession of a current license to practice as a Registered Nurse issued by the Pennsylvania State Board of Nursing; or Possession of a ... possessing non-renewable temporary practice permits must obtain licensure as a Registered Nurse within the one-year period as defined by the Pennsylvania State Board… more
- PAX Health (New York, NY)
- …and individuals can thrive in their journey towards well-being. The Advanced Practice Nurse (APN) with experience in workers' compensation plays a critical role in ... facilitate treatment authorization, progress updates, and return-to-work planning . Review workers' compensation reports, diagnostic results, and independent medical… more
- VetJobs (Tampa, FL)
- …internal and/or external resources for specific activities required to effectively evaluate claims , such as Subrogation, Risk Control, nurse consultants nurse ... negotiating and resolving assigned Construction Defect and latent Property Damage claims . Provides quality claim handling throughout the claim life cycle (customer… more
- Ethos Risk Services (Houston, TX)
- …clients and expanding existing relationships, specifically within the medical management sector ( nurse case management, IME, utilization review , and medical bill ... ABOUT US: Ethos is a leading insurance claims investigation and medical management company committed to...compensation and/or liability. Preferred: Experience in B2B sales within nurse case management, IME, utilization review , and… more
- Vital Care Infusion Services (Pittsburgh, PA)
- …practice limits. Credentialing/re-credentialing and Contract applications. Duties/Responsibilities: Review patient files for completeness and accuracy, identify ... and audit claims , ensure all revenue opportunities are included, and complete...Assist with processing online adjudication of collection issues and nurse billing as assigned. Perform other related duties as… more
- PartnerRe (Maple Grove, MN)
- …accommodation or other reasons. Develop relationships with assigned clients and producers. Review assorted claims , trigger reports, and 50% notice reports to ... financially. They provide clinical expertise to PartnerRe's underwriting and claims departments to ensure insightful administration of PartnerRe Health's products.… more
- Kimberly-Clark Corporation (Atlanta, GA)
- …Reps) by providing the voice of sales for pricing, promotions, product training, claims resolution, and loyalty programs all in one easy-to-use access point. Design ... strategies. Lead initiatives to digitize and streamline order management, claims , and coupon resolution processes. Cross-Functional Collaboration Marketing: Collaborate… more
- Iconma LLC (Syracuse, NY)
- …documents any relevant medication history and missing information to assist the pharmacist/ nurse /physician in the review process. Develops and implements process ... improvement to increase efficiency in the review process for the clinical staff. Works with requesting...care and claim processors to coordinate pharmacy and/or medical claims with prior authorization information on file or needed… more
- People, Inc. (Rochester, NY)
- …as the agency liaison between EI and Health Home referral sources. Review staff documentation, confirming regulatory adequacy and timeliness, including review ... in improvement of performance. Ensure all Participant records, Medicaid fiscal claims records, administrative documents, are retained as required by applicable… more
- Bristol Health (Bristol, CT)
- …skilled physicians and advanced practice providers. We are seeking a physician assistant or nurse practitioner to join a staff of one physician and four PA's to ... the American Nurses Credentialing Center or American Academy of Nurse Practitioners, valid Connecticut medical license, Connecticut Controlled Substance Registration… more
- CAMC Health System (Charleston, WV)
- …rendering services to the patient, as directed by the provider or Registered Nurse if applicable as outlined in departmental policies and procedures. Duties may ... summary logs for charges, payments, balances due, statistical reports, billing claims , daily deposit transactions and equipment loan-outs. Responsible for answering… 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
- US Tech Solutions (Columbia, SC)
- …or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare continuum to ... promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... exceptions, coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care… more
- Staffing Solutions Organization (Augusta, ME)
- …which is a reflection of our clients and the people they serve. **Registered Nurse - Authorization Review Unit - MaineCare in Augusta, ME** **Position Duties:** ... by the PA supervisor, utilizing PA software tools; + Review and authorize provider requests for the following services...PAs; + Collaborate with other OMS units to resolve claims issues that involve PAs; + Respond to questions… more
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