- TulaRay (Harrisburg, PA)
- …as follows: Identify discrepancies through analysis of computer reports, PROMISe (TM) claims history profiles, MCO encounter data, other Medical Assistance (MA) ... of a current license to practice as a Registered Nurse issued by the Pennsylvania State Board of Nursing;...and on-site reviews and recipient interviews to verify/assess the medical care rendered by providers, including the review… more
- PAX Health (New York, NY)
- …planning . Review workers' compensation reports, diagnostic results, and independent medical evaluations (IMEs) to address any medical concerns and integrate ... 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… 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
- CAMC Health System (Charleston, WV)
- …by policy, and disposition of calls. Retrieve, photocopy, as necessary and file medical records; prepare, review and process records to ensure completeness and ... rendering services to the patient, as directed by the provider or Registered Nurse if applicable as outlined in departmental policies and procedures. Duties may… more
- Ethos Risk Services (Houston, TX)
- …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...sales within nurse case management, IME, utilization review , and medical bill review .… more
- Vital Care Infusion Services (Pittsburgh, PA)
- …in required intervals. Investigate and verify benefits for pharmacy and medical third-party claims . Obtain prior authorizations; initiate requests, follow ... of launch, growth, and successful business operations. What we offer: Comprehensive medical , dental, and vision plans, plus flexible spending, and health savings… 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 ... is designed with extensive support services. PartnerRe's PULSE + Plus (TM) Medical Management Program is an integrated, state-of-the-art program that partners with… more
- Iconma LLC (Syracuse, NY)
- …pharmacy help desk, customer care and claim processors to coordinate pharmacy and/or medical claims with prior authorization information on file or needed for ... documents any relevant medication history and missing information to assist the pharmacist/ nurse /physician in the review process. Develops and implements process… 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
- Bristol Health (Bristol, CT)
- …by the American Nurses Credentialing Center or American Academy of Nurse Practitioners, valid Connecticut medical license, Connecticut Controlled Substance ... Make a difference. Make Bristol Health your choice. Bristol Health Medical Group is seeking compassionate, mission-focused healthcare providers to join its… 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
- 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
- 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
- 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
- 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 ... coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care initial… 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:** ... + Manage medical Prior Authorizations (PA) as assigned by the PA...by the PA supervisor, utilizing PA software tools; + Review and authorize provider requests for the following services… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, evidence-based guidelines, insurance ... guidelines to determine the appropriate level of care and the medical necessity of continued hospitalization. Secures initial payer authorization and continued… more
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