- Molina Healthcare (Covington, KY)
- … and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Provides support for … more
- Bon Secours Mercy Health (Cincinnati, OH)
- …required by their supervisor, subject to reasonable accommodation. Licensing/Certification + Active Registered Nurse ( RN ) - Required + Active ... + Participates in process improvement, professional development, and peer review . + Maintains active RN licensure within...multistate/compact registered nurse ( RN ) licensure - Required ( _if… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …quality, patient safety, and performance improvement committees and projects as needed. Supports Medical Staff Quality and Peer Review . **Primary focus will be ... and clinicians are recognized for clinical and operational excellence. RN Quality Specialist Summary: Ensures the delivery of high... medical staff bylaws. Includes support of the Medical Staff Quality/Peer Review function. + Collects… more
- Insight Global (Cincinnati, OH)
- …Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills and Requirements Registered Nurse * 2 years experience of neuro, ... Global Health is looking for an experienced Trauma OR Nurse for one of our large Level 1 Trauma...Trauma Center clients in the Cincinnati, OH area! The Medical Center is opening brand new facility and adding… more
- Elevance Health (Mason, OH)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 ... opportunities for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical...Skills, Qualifications, and Experiences:** + Fraud and Abuse experienced Nurse with a CPC are highly desired. For candidates… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …required by their supervisor, subject to reasonable accommodation. Licensing/Certification + Active Registered Nurse ( RN ) - Required + Active ... + Participates in process improvement, professional development and peer review + Maintains active RN licensure within...multistate/compact registered nurse ( RN ) licensure - Required ( _if… more
- Molina Healthcare (Covington, KY)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Covington, KY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The Care Review Clinician ( RN ) provides support for...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent… more
- Molina Healthcare (Covington, KY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent… more
- Molina Healthcare (Covington, KY)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. **Preferred… more
- Molina Healthcare (Covington, KY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Covington, KY)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- CenterWell (Fort Mitchell, KY)
- …+ Graduate of an accredited School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's license, auto insurance ... + Assesses staff education needs based on own the review of clinical documentation in addition to feedback and...and reliable transportation. + Two years as a Registered Nurse with at least one-year of… more
- Molina Healthcare (Covington, KY)
- … claims review , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in the ... JOB DESCRIPTION Job Summary The RN Lead, DRG Coding/Validation provides lead level support...validation tools and process improvements - ensuring that member medical claims are settled in a timely fashion and… more
- Fresenius Medical Center (Cincinnati, OH)
- **PURPOSE AND SCOPE:** Functions as part of the hemodialysis health care team as a Registered Nurse Applicant, under the direction or supervision of a Staff ... Registered Nurse , to ensure provision of quality patient care on a daily basis in accordance with FMS policies, procedures, and training. Supports the FMCNA's… more
- IQVIA (Cincinnati, OH)
- Our **MedTech Registered Nurse Liaison** experiences a unique opportunity and leverage your clinical expertise in a dynamic role that goes beyond bedside care. ... with healthcare professionals and advocate for the well-being of patients through medical device technology. You will be responsible for assisting the service team… more
- Elevance Health (Mason, OH)
- …preferred. + 3 years of clinical experience as a Registered Nurse is strongly preferred. + Experience reviewing medical records, investigation, and/or ... ** Nurse Appeals** **Location:** This role enables associates to...+ Extrapolates and summarizes medical information for medical director, consultants and other external review .… more
- Fresenius Medical Center (Cincinnati, OH)
- …task performed in the Home Therapies program under the direct supervision of the Home Therapies registered nurse (HT RN ) and in compliance with state laws. + ... information and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient...obtain vital signs + Collect patient's treatment records and review for completion. Notify RN of incomplete… more
- Elevance Health (Mason, OH)
- …formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The ** Nurse Audit Senior** will be responsible ... ** Nurse Audit Senior - Payment Integrity Complex and...impact:** + Investigates potential fraud and over-utilization by performing medical reviews via prepayment claims review and… more
- Elevance Health (Cincinnati, OH)
- …+ Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. ... ** Nurse Reviewer I** **Virtual:** This role enables associates...meets medical necessity criteria or requires additional medical necessity review . + Conducts initial … more