- New York State Civil Service (Melville, NY)
- …Compensation Board Medical Treatment Guidelines for Claims Service Managers and other Claims staff. Each Registered Nurse 2 will be assigned to one of ... NY HELP Yes Agency Insurance Fund, State Title Registered Nurse 2 - Medical Care (NY HELPS) Occupational Category...public health, community health, visiting nursing, occupational health, utilization review , or review of medical records from… 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 (St. Petersburg, FL)
- Job Description Position Overview: The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay comprehensive ... 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
- Martin's Point Health Care (Portland, ME)
- …and performs medical necessity reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate ... Work" since 2015. Position Summary Job Description The Utilization Review Nurse works as a member of...internal guidelines for medical necessity reviews. + Manage the review of medical claims disputes, records, and… more
- Robert Half Accountemps (Grand Rapids, MI)
- Description We are looking for a Claims Specialist to join our team in Grand Rapids, MI. This role involves handling all aspects of workers compensation lost time ... claims and maintaining strong customer relations throughout the process....strong customer relations are maintained throughout the process. * Review claim and policy information to provide background for… more
- Martin's Point Health Care (Portland, ME)
- …Utilization Review Nurse works as a member of the Utilization Review Team and is responsible for reviewing claims disputes and retrospective requests for ... clinical review prior to payment. The Utilization Review Nurse will use appropriate governmental policies...medical outcomes. Job Description Key Outcomes/Results: + Manages the review of medical claims disputes, records, and… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …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 (SHIFT: ... 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
- 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
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- Utilization Review Nurse (40 Hour) Office/On-Site Recruitment # 240604-5612FP-002 Location Hartford, CT Date Opened 6/5/2024 12:00:00 AM Salary $76,565 - ... 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
- Public Consulting Group (Augusta, ME)
- **Overview** **Registered Nurse - Health Services Consultant** **Authorization Review - Office of MaineCare Services in Augusta, ME** This role will be Fulltime ... 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
- LTCG (MN)
- * Review onsite assessments for consistency and quality and collaborates with the field nurse . * Obtain information from the field assessor to clarify ... company formats, when appropriate. * Manages the clinical quality review for the completed assessments. * Act with independent...the department. * Other duties as assigned. * Registered Nurse : Two years of geriatric experience or * Licensed… more
- Trinity Health (Farmington Hills, MI)
- …denial and appeal activities with Ministry Organization (MO) based Utilization Review /Case Management departments; + Reviews and understands utilization review ... reviews findings with all levels of Payment Resolution Specialist for further review . Serve as a resource to Payment Resolution Specialists providing guidance and… more
- State of Nevada (NV)
- …Medicaid services, including appropriateness for out of state placements. The HCC Nurse also is the dedicated clinical reviewer for eligibility determinations ... HEALTH CARE COORDINATOR 3 - NURSE APPROXIMATE ANNUAL SALARY - $63,308.16 to $94,335.84...validate and ensure adequacy of services and resident care. Review health care providers and fiscal agents to ensure… more
- Pilgrim's (Moorefield, WV)
- …Position Description MOOREFIELD PREPARED FOODS Position Title: Occupational Health Nurse Evening Shift Employee: Reports to: Occupational Health Manager Department: ... Salaried Non Exempt Pay Grade: Salaried Non Exempt Author: Reviewer : Position Summary: In two - four sentences, what...area medical community in dealing with WV Workers Compensation claims Report s all Lost Time and Recordable injuries… more
- UPMC (Pittsburgh, PA)
- …accurate reimbursement. Clinical guidance and support to Fraud and Abuse department. Clinical review for high dollar claims and other clinical guidance as needed ... is looking for a Senior Manager, Clinical and Coding Review to join the Quality Assurance team!** Directs and...processes, audits, summaries and meeting as need with external reviewer . + Serves as an instructor and discussion leader.… more
- Vighter Medical Group (San Antonio, TX)
- QTC Nurse Practitioner PT Job Details Job Location San Antonio TX - San Antonio, TX Position Type Part Time Education Level Master's Degree Travel Percentage None ... Job Shift Day Job Category Health Care Description Position Description: Nurse Practitioner to perform compensation and pension examinations as a Vighter LLC employee… more
- CVS Health (Harrisburg, PA)
- …payment through identification of disallowed billed charges through Internal Itemized Bill Review . This Nurse Coder position reviews hospital itemized bills to ... both internal payment policies and Medicare payment policies the Nurse Coder ensures all billed line items align with...review of routine to complex high dollar facility claims . + Communicate with various levels of Network Management… more
- GEHA (Lee's Summit, MO)
- …personalized customer experience, sustained by a nimble and efficient organization. The Nurse Consultant II provides professional nursing care to our members through ... of the member on how to close those gaps, review of clinical history, and review of...and/or clinical and/or plan policy development and management. The Nurse Consultant II will be involved in research and… more