- Molina Healthcare (Louisville, 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
- Fresenius Medical Center (Louisville, KY)
- …communicated to and implemented by the facility staff. + Maintains integrity of medical records and other FMS administrative and operational records. + Complies with ... as pertinent. **STAFF:** + Responsible for implementation of FMS staffing, and medical supply models, to provide quality patient care, and makes recommendations. +… more
- Elevance Health (Louisville, KY)
- **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
- Molina Healthcare (Louisville, 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 (Louisville, 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 (Louisville, 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 (Louisville, 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 (Louisville, 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 (Louisville, 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
- ChenMed (Louisville, KY)
- …to join our team. The Community Care team is a multidisciplinary service including Registered Nurse ( RN ) Community Care nurses, Licensed Practical Nurse ... patients and their primary care physicians to meet their medical and social needs with the aims of fully...has completed their episode of care management the register nurse ( RN ) will review patient… more
- Molina Healthcare (Louisville, 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
- Elevance Health (Louisville, KY)
- …and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a ... **Diagnosis Related Group Clinical Validation Auditor- RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This role enables associates to work virtually full-time,… more
- Fresenius Medical Center (Louisville, KY)
- …effective dialysis therapy for assigned patients under the direct supervision of a registered nurse . Participates in the implementation and evaluation of patient ... as your own._ **Connect with your goals and change lives** **with Fresenius Medical Care North America.** Here, we make connections that empower patients, their… more
- Elevance Health (Louisville, KY)
- …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
- Fresenius Medical Center (Radcliff, KY)
- …Report any significant information and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine ... policy. Report any change or unusual findings to the registered nurse or supervisor. + Perform and...+ Monitors patients performing self-care under the supervision of RN . **Staff Related** + Assists in training of applicable… more
- Fresenius Medical Center (Louisville, KY)
- …DUTIES AND RESPONSIBILITIES:** Providespatient care under the directsupervision of Hemodialysis Registered Nurse for assignedpatient(s) in the dialysissuite in ... the individual patient record to include the hospital Electronic Medical System (EMS) and the Acute Care Electronic System...patientprior to dischargeand reports any unusualfindings to the FMCNA RN + Review and comply with the… more
- Molina Healthcare (Louisville, KY)
- …related field or equivalent experience, OR completion of any of the following programs: + Registered Nurse ( RN ) or State Licensed Vocational Nurse (LVN), ... in support of annual HEDIS project management and ongoing review of medical records submitted by providers....OR completion of any of the following programs: + Registered Nurse ( RN ) or State… more
- Veterans Affairs, Veterans Health Administration (Fort Knox, KY)
- …generally consists of a primary care provider (MD, NP, PA), registered nurse care manager, clinical associate (LPN or medical assistant/ health technician) ... range of medical clinicians across multiple disciplines (eg medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social… more
- Molina Healthcare (Louisville, KY)
- …Microsoft Excel (edit/save spreadsheets, sort/filter) **Required License, Certification, Association** Licensed registered nurse ( RN ), Licensed practical ... CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or for payment… more
- Signature Healthcare (Louisville, KY)
- …with all changes and as appropriate. What you Need to make a Difference + Registered Nurse with required current state licensure. + Minimum three (3) years of ... assessment and meeting with families. Knowledgeable of nursing and medical practices and procedures, as well as laws, regulations,...end meetings to assure federal billing requirements are met. Review Plan of Care at least quarterly and with… more