- Zurich NA (Schaumburg, IL)
- Medical Bill Review Senior Nurse...and resolve issues by working with corporate law, Technical Claims and other, as necessary. + Prepare, attend and ... 127127 Zurich Insurance is currently looking for a ** Medical Bill Review Senior Nurse ** to work from our Schaumburg, IL office. With limited direction,… more
- Molina Healthcare (Kenosha, WI)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... schedule) Looking for a RN with experience with appeals, claims review , and medical coding....clinical/ medical reviews of retrospective medical claim reviews, medical claims and… more
- Molina Healthcare (Kenosha, WI)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...for clinical member services review assessment processes. Responsible for verifying that services are… more
- Molina Healthcare (Kenosha, WI)
- …quality assurance, recovery auditing, DRG/clinical validation, utilization review and/or medical claims review , or equivalent combination of relevant ... validation tools and process improvements - ensuring that member medical claims are settled in a timely...education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Molina Healthcare (Kenosha, WI)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review … more
- Molina Healthcare (Kenosha, WI)
- … claims with corresponding medical records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines, and provider ... policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or… more
- Molina Healthcare (Kenosha, WI)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- Molina Healthcare (Kenosha, WI)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- Nestle (Schaumburg, IL)
- …other health care agencies and third party administrators for worker's compensation claims + Maintain confidential medical records to include pre-employment ... + Graduate of an accredited school of nursing, Registered Nurse in the State of Illinois + Minimum of...use **SKILLS & EXPERIENCE:** + Experience with Workers' Compensation claims management + Experience with OSHA recordkeeping and maintaining… more
- Veterans Affairs, Veterans Health Administration (Kenosha, WI)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... for their respective clinic(s), and in collaboration with the Nurse Manager is responsible for all daily operations. It...performs a variety of duties in a complex 1C medical facility, which is constantly evolving within a highly… more