- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The RoleThe Claims Nurse Reviewer is responsible for reviewing claims , validating ... position requires strong clinical and medical coding skills to review claims for medical necessity, appropriate coding,...part of the Complex Claims team, the Claims Nurse Reviewer will serve… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …and eliminating fraud, waste and abuse. Responsibilities: + Perform the clinical review in Standard Claims Processing System files (eg, medical records, ... of medical terminology and experience in the analysis and processing of claims , utilization review , quality assurance procedures, payment methodologies and Part… more
- Serco (Washington, DC)
- …criteria: + A minimum of three (3) years' experience practicing nursing as a licensed Registered Nurse ; + A minimum of three (3) years' experience in a ... **Position Description** Serco is seekinga motivated Medical Review Subject Matter Expert to join...+ Hold a Bachelor's Degree in Nursing + Current Registered Nurse Licensure + CPC Certification If… more
- Blue Cross and Blue Shield of Louisiana (Monroe, LA)
- …to peers while maintaining performance standards is required **Licenses and Certifications** + Nursing\ RN - Registered Nurse - State Licensure And/Or Compact ... for coordinating, processing and managing all in-patient and out-patient claims from a medical standpoint to ensure proper administration...State Licensure Must be a Registered Nurse with a current Louisiana license.required… more
- CareFirst (Baltimore, MD)
- …in addition to the required work experience. **Licenses/Certifications Upon Hire Required:** + RN - Registered Nurse - State Licensure And/or Compact ... the overall Corporate Strategic Plan through direction of the Clinical Medical Claims Review , Medical Underwriting, Medical Policy, Clinical Appeals and Analysis… more
- Houston Methodist (Nassau Bay, TX)
- …performance that demonstrates progressive leadership abilities **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure ... specifications. + Manages utilization management (UM) programs including Medical Claims Review , Precertification and Reconsiderations and Appeals....and/or Compact State Licensure within 60 days **OR** + RN -Temp - Registered Nurse -… more
- Blue KC (Workman, MN)
- …of URAC and NCQA(R) guidelines and state and federal regulations. + Valid and active Registered nurse ( RN ) in Missouri and Kansas. + Valid and active ... + Ensures proper payment of pre-transplant, transplant, and post-transplant claims . Sets up transplant pre-pay review for... Registered nurse ( RN ) licensure in… more
- Public Consulting Group (Cedar Rapids, IA)
- …+ Ability to successfully monitor and ensure the quality of data analytic and clinical review activities. + Knowledge of claims and medical record review ... for coordinating program integrity-related reviews with the medical necessity review team responsible for conducting medical necessity reviews, ensuring services… more
- CareFirst (Owings Mills, MD)
- …**QUALIFICATIONS:** **Education Level:** High School Diploma or GED. **Licenses/Certifications Upon Hire:** + RN - Registered Nurse - State Licensure And/or ... review by compiling clinical, contractual, medical policy and claims information along with corporate and appellant correspondence. Formulates recommendations… more
- University of Utah Health (Salt Lake City, UT)
- …high dollar and frequent utilizers. + Collaborate with unit case manager, utilization review nurse and other organization staff on establishing an appropriate ... It utilizes skills and knowledge as a subject matter expert to guide case management and facility staff to...**Licenses Required** + Current license to practice as a Registered Nurse in the State of Utah,… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …services **Required Licensure and Certifications:** Current unrestricted licensure as a Registered Nurse in the state of Washington National certification ... you will find the safest and highest quality of care provided by our expert , compassionate medical care team at 11 hospitals and nearly 300 sites throughout the… more
- Hackensack Meridian Health (Hackensack, NJ)
- …or Interqual. **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. **Licenses and Certifications Preferred:** + ... Nurse Specialist** will be responsible for the timely review and submission of appeals for denied managed care...of appeals for denied managed care inpatient and/or outpatient claims to insurance companies for reconsideration of denials and/or… more
- NHS Management, LLC (Fayetteville, AR)
- …with company match + Paid Holidays and Paid Vacation Requirements + Must be a Registered Nurse in good standing + Previous experience in a supervisory capacity ... way. We are in search of a qualified Regional Nurse Consultant: The Regional Nurse Consultant will... Consultant will be responsible for the dissemination of expert advice and oversight to facility management personnel and… more
- Carnival Cruise Line (Miami, FL)
- … claims experience required. **Knowledge, Skills and Abilities:** + Expert -level writing skills. Strong organizational skills and the ability to prioritize ... a general knowledge of organizational insurance programs and resources and managing claims against the organization; interfacing with legal defense counsel and … more
- Trinity Health (Syracuse, NY)
- …or workplace investigations, injury case management and/or OSHA recordkeeping.** ** RN preferred** **SPECIAL EQUIPMENT, SKILLS, OR OTHER REQUIREMENTS:** **Strong ... **Management** **Responsibilities:** **The Colleague Safety Specialist is the subject matter expert for the THNY colleague injury loss control programs and is… more
- Trinity Health (Albany, NY)
- …safety or workplace investigations, injury case management and/or OSHA recordkeeping. + RN preferred + Certified CPPS or equivalent preferred. Required within 2 ... Management **Responsibilities:** + The Colleague Safety Specialist is the subject matter expert for the THNY colleague injury loss control programs and is… more
- Commonwealth Care Alliance (Boston, MA)
- …Yes **What You'll Be Doing:** + Function as the IT subject matter expert for Ancillary & Pharmacy integrations, platforms, and tools. + Collaborate with IT ... and deliver business outcomes. + Consult with business unit's and review IT usage, services, technology, and department specific projects. Identify, forecast… more