- SR International, Inc. (Phoenix, AZ)
- …Candidate needs to obtain their own laptop SOAZ - Posting ID # 5297 - Medical Review Nurse (Local Only/Mostly Remote/Onsite Trainings) Skills Required: * ... times for training once starting position Compliance Items: Active RN License in state of Arizona Fingerprint Clearance Card...and evaluation *InterQual Criteria *CCI *Coding: CPT, HCPCS, ICD-9 * Medical Claims Review *Statistical analysis… more
- Aveanna Healthcare (Huntsville, AL)
- Position Overview: The RN or PT Executive Director is directly responsible for the administrative and leadership functions associated with all operations of an ... and ensuring compliance with Aveanna's policies and procedures. **We are open to an RN or Physical Therapist for this position. This role is an onsite position and… more
- Aveanna Healthcare (Brainerd, MN)
- …Management/Issue Resolution Plan and implement branch growth strategies Thorough review of financial statements, activity reports, and other performance data ... regulations Oversight if internal billing and collection efforts to generate clean claim Aveanna Healthcare Offers: Quarterly bonus plan 401(k) with Company match… more
- PharmaCord (Jeffersonville, IN)
- …clearly and articulately Have a positive attitude! Education & Experience: Licensed Registered Nurse 2-3 years nursing with experience in rare disease, ... report it to our Talent Acquisition team immediately at ###@pharmacord.com The Nurse Program Manager plays a pivotal role in optimizing the operational performance… more
- Molina Healthcare (Warren, MI)
- …work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and ... Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in … more
- Molina Healthcare (Long Beach, CA)
- …clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review . **Required License, Certification, Association** Active, ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...Nurse (LVN) license in good standing. **Preferred Education** Registered Nurse . Bachelor's Degree in Nursing or… more
- Emanate Health (Covina, CA)
- …and the #19 ranked company in the country. **J** **ob Summary** The Manager, Medical Necessity Review & Appeals is responsible for overseeing the evaluation of ... medical necessity, appropriateness, and cost-effectiveness of healthcare services, as...as well as managing the appeals process for denied claims . This role ensures compliance with federal, state, and… more
- Medical Mutual of Ohio (OH)
- …perform pre-employment substance abuse and nicotine testing._ **Title:** _Clinical Appeal & Claim Review Nurse II_ **Location:** _Ohio_ **Requisition ID:** ... of care. **Responsibilities** + Independently evaluates basic to complex medical claims and/or appeal cases and associated...+ 3 years experience as a Registered Nurse in acute care, critical care, emergency medical… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... protocol sets, or clinical guidelines and provide support and review of medical claims and...customer service skills required. **Minimum License Requirement :** California RN license. Delivering world-class health care one patient at… more
- InGenesis (Columbia, SC)
- InGenesis is currently seeking a Registered Nurse / RN - Managed Care Coordinator to work for our client located in Columbia, SC. In this role you will ... any questions you may have. Job Duties * Perform medical review /authorization process. * Ensure coverage for...Perform other duties as assigned. Minimum Qualifications * Current Registered Nurse / RN license… more
- St. Luke's University Health Network (Allentown, PA)
- …near vision, visual monotony. EDUCATION: Graduate of an accredited professional nursing program. Registered nurse with current license to practice in the state ... Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks outcomes regarding appeal process. Assists billing staff… more
- US Tech Solutions (Columbia, SC)
- **Job Description:** + Must be an RN in SC and have an active and...level. If not, then it would be sent for review with our medical director. We would ... unrestricted SC RN license. + Hours/Schedule - M-F 8:30am - 5pm....resources to promote quality, cost effective outcomes. + Performs medical or behavioral review /authorization process. Ensures coverage… 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 ... the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) **About US Tech… more
- US Tech Solutions (Columbia, SC)
- …to elicit behavior change and increase member program engagement. + Performs medical or behavioral review /authorization process. Ensures coverage for appropriate ... temp to hire)** **Job Description:** + Must be an RN in SC and have an active and unrestricted...with triage when needed. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria… more
- The County of Los Angeles (Los Angeles, CA)
- …be active and unrestricted. Successful candidates are required to provide proof of their Registered Nurse ( RN ) License and Basic Life Support (BLS) ... REGISTERED NURSE I/RELIEF NURSE ...vaccination against COVID-19 or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates… 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 ... II: Two (2) years of experience as a registered nurse , of which one year must...may be involved. SPECIAL REQUIREMENTS INFORMATION: * An Utilization Review Nurse is an RN … more
- The County of Los Angeles (Los Angeles, CA)
- REGISTERED NURSE I, SHERIFF (CORRECTIONAL HEALTH) Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2930992) Apply REGISTERED NURSE ... is currently offering up to 20% bonus for full-time Registered Nurse I, Sheriff positions hired by...vaccination against COVID-19 or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates… more
- MyFlorida (St. Augustine, FL)
- …that all verbal orders, including telephone orders from attending physicians are reviewed by a registered nurse . If no RN is available, receive all telephone ... SENIOR REGISTERED NURSE SUPV - 50950032 Date:...history must be verifiable. Please attach any credentials you claim (degrees, certifications, etc.) to your application. *Other vacant… more
- Ascension Health (Baltimore, MD)
- …management rules and regulations. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Maryland Board of Nursing ... cases. + Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. +… more
- Montana State University (Bozeman, MT)
- …regarding this position, please contact: Maricia Owens, RN , BSN , Nurse Manager ### (tel:###) ###@montana.edu Classification Title Registered Nurse ... /Clinic Mgr - BZ Working Title Registered Nurse Brief Position Overview Great opportunity for a ...(summers off), benefits eligible. Position Number 4N1298 Department SWC Medical Division Division of Student Success Appointment Type Classified… more
