- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The RoleThe Claims Nurse Reviewer is responsible for reviewing claims , validating ... position requires strong clinical and medical coding skills to review claims for medical necessity, appropriate coding,...part of the Complex Claims team, the Claims Nurse Reviewer will serve… 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
- Lincoln Financial Group (Columbus, OH)
- …a Glance** We are excited to bring on a highly motivated Integrated Absence Claims Specialist to staff our ever-growing claims organization. As an Integrated ... Claims Specialist, you will manage a workload of Short-Term Disability claims and their associated leaves. You will be responsible for conducting initial and… more
- Office of Personnel Management (Washington, DC)
- …the health benefits Plan and providers. Consult with internal clinical advisors (eg nurse ) to resolve disputed health benefits claims and develop responses to ... Summary As a Legal Administrative Specialist (Insurance Benefits Claims Examiner), you will be part of Healthcare and Insurance, Office of Personnel Management. If… more
- Lincoln Financial Group (Columbus, OH)
- …Role at a Glance** We are excited to bring on a highly motivated **Group Claims Specialist** to support our ever-growing claims organization in a work from home ... to support our west coast employer groups. _Background details_ As a Group Claims Specialist, you will support our Short Term Disability or Integrated Absence teams.… 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
- State of Connecticut, Department of Administrative Services (New Haven, CT)
- Utilization Review Nurse (40 Hour) Office/On-site Recruitment # 240514-5612FP-001 Location New Haven, CT Date Opened 5/16/2024 12:00:00 AM Salary $76,565* - ... Addiction Services ( DMHAS (https://portal.ct.gov/DMHAS/About-DMHAS/Agency/About-DMHAS) ) as a Utilization Review Nurse (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5612FP&R1=&R3=) ! We are recruiting… 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
- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... reviews for acute and subacute rehabilitation, transportation and DME requests. Review of identified high-cost admissions and extended stays and inpatient… 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
- Blue Cross and Blue Shield of Louisiana (Monroe, LA)
- …Responsible for coordinating, processing and managing all in-patient and out-patient claims from a medical standpoint to ensure proper administration of contractual ... performance standards is required **Licenses and Certifications** + Nursing\RN - Registered Nurse - State Licensure And/Or Compact State Licensure Must be a… more
- US Tech Solutions (Houston, TX)
- …implements, and maintains educational tools to help providers reduce the submission of claims for non-covered services and reduce the claims payment error rate. ... compliance. + Provides clinical input for internal requests. Serves as reviewer to determine inter-rater reliability. **Experience:** + 7 years-clinical experience… 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
- Elevance Health (Columbus, OH)
- …of utilization and/or fraudulent activities by health care providers through prepayment claims review , post payment auditing, and provider record review ... ** Nurse Audit Lead** **Supports the Carelon Payment Integrity...make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with… more
- State of Georgia (Fulton County, GA)
- …Specific, additional experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT ... Nurse Investigator Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/51086/other-jobs-matching/location-only) Hot… 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
- US Tech Solutions (Columbia, SC)
- …provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate, ... effective outcomes. Responsibilities: . *50% Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit… more
- UNC Health Care (Rocky Mount, NC)
- … Review staff), and 3) reviews and appeals for hospital patient accounts/ claims denied payment through retrospective or prospective review , ie - Medicare ... and well-being of the unique communities we serve. **Summary:** The Recovery Audit Nurse will work closely with other Business Office staff members to assist in… more
- The County of Los Angeles (Los Angeles, CA)
- CLINIC LICENSED VOCATIONAL NURSE I/LICENSED VOCATIONAL NURSE I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2930097) Apply CLINIC ... LICENSED VOCATIONAL NURSE I/LICENSED VOCATIONAL NURSE I Salary $51,756.00...in preparing for the test, we advise you to review all related materials that you deem necessary. +… more