- Molina Healthcare (Santa Fe, NM)
- … 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
- CVS Health (Santa Fe, NM)
- …Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS...setting. + A Registered Nurse that holds an active, unrestricted… more
- Molina Healthcare (Santa Fe, NM)
- 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 (Santa Fe, NM)
- For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state they reside This role will be doing Utilization review for ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… more
- Molina Healthcare (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …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 (Santa Fe, NM)
- …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
- Humana (Santa Fe, NM)
- …Typical work hours are Monday-Friday, 8 hours/day, 5 days/week. **Required Qualifications** + Registered Nurse ( RN ), holding an active and unrestricted ... resources, schedules and goals. The Manager, Fraud and Waste Investigator: Nurse Audit/ Review validates and interprets medical documentation to ensure… more
- Humana (Santa Fe, NM)
- …an impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and… more
- Evolent (Santa Fe, NM)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... for performing precertification and prior approvals. Tasks are performed within the RN /LVN/LPN scope of practice, under Medical Director direction, using… more
- Humana (Santa Fe, NM)
- …alternate time zone virtually. **Use your skills to make an impact** **Required Qualifications** + Registered Nurse ( RN ) with 3 years or more of NICU level ... us put health first** The NICU Care Manager, Telephonic Nurse 2, in a telephonic environment, assesses and evaluates...other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines… more
- Molina Healthcare (Santa Fe, NM)
- …**JOB QUALIFICATIONS** **Required Education** Any of the following: Completion of an accredited Registered Nurse ( RN ), Licensed Vocational Nurse (LVN) ... clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ), Licensed Vocational Nurse (LVN)… more
- Highmark Health (Santa Fe, NM)
- …to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and ... in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or...Working knowledge of pertinent regulatory and compliance guidelines and medical policies + Ability to multi task and perform… more
- Zurich NA (Santa Fe, NM)
- …+ Experience leading operational initiatives and/or work streams Preferred Qualifications: + Licensed Registered Nurse ( RN ) in the state of residence + ... Sr Supplier Medical Process Specialist 128416 Zurich North America is...years of experience in the Nursing areaAND + Licensed registered nurse in state of residence +… more
- Molina Healthcare (Santa Fe, NM)
- …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
- Intermountain Health (Santa Fe, NM)
- …organization that invests in your growth** -with many career paths to explore, like Medical Assistant Senior, Registered Nurse , Practice Manager, and more! + ... MA certification from one of the following national MA certifications or registrations: Registered Medical Assistant (RMA) of AMT, National Certified Medical … more
- Molina Healthcare (Santa Fe, NM)
- …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
- CVS Health (Santa Fe, NM)
- …Service/Health Services (as applicable to hiring program) or Associates degree with a Registered Nurse with Behavioral Health experience/ background with 3 years ... based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. Utilizes clinical experience and skills… more