- Molina Healthcare (Nampa, ID)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... **Job Duties** + Performs clinical/ medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which… more
- Medical Mutual of Ohio (OH)
- …perform pre-employment substance abuse and nicotine testing._ **Title:** _Clinical Appeal & Claim Review Nurse II_ **Location:** _Ohio_ **Requisition ID:** ... of care. **Responsibilities** + Independently evaluates basic to complex medical claims and/or appeal cases and associated...+ 3 years experience as a Registered Nurse in acute care, critical care, emergency medical… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse ( RN ) who comprehensively conducts point of entry and ... concurrent medical record review for medical ...in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- Independent Health (Buffalo, NY)
- …collaboration. **Overview** The Utilization Review Nurse (URN) performs clinical review to determine the medical necessity of requested services. The URN ... Degree in Nursing required; Bachelor's degree preferred. Current, active, unrestricted, and licensed registered nurse ( RN ) required. + Two (2) years of… more
- US Tech Solutions (Columbia, SC)
- …Utilizes available resources to promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for ... needs of our members. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria...the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse … more
- Ascension Health (Tulsa, OK)
- …management rules and regulations. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Oklahoma Board of Nursing ... cases. + Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. +… more
- InGenesis (Columbia, SC)
- InGenesis is currently seeking a Registered Nurse / RN - Managed Care Coordinator to work for our client located in Columbia, SC. In this role you will ... any questions you may have. Job Duties * Perform medical review /authorization process. * Ensure coverage for...Perform other duties as assigned. Minimum Qualifications * Current Registered Nurse / RN license… more
- Ascension Health (Manhattan, KS)
- …rules and regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Kansas Board of Nursing ... cases. + Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. +… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... protocol sets, or clinical guidelines and provide support and review of medical claims and...customer service skills required. **Minimum License Requirement :** California RN license. Delivering world-class health care one patient at… more
- HCA Healthcare (Portsmouth, NH)
- …you, we encourage you to apply for our Occupational Health Registered Nurse opening. Our team will promptly review your application. Highly qualified ... their positions. Join our Team as a(an) Occupational Health Registered Nurse and access programs to assist...taking vital signs, patient assessment, taking history of injury, medical history review , blood drawing, TB testing… more
- Henry Ford Health System (Troy, MI)
- …with department standards regarding productivity and audit quality. CERTIFICATIONS/LICENSURES REQUIRED: Registered Nurse credentialed from the Michigan Board of ... + Bachelor's in nursing (BSN) preferred. + Experience in medical record review , billing and coding accuracy...accessing portals when needed. + Conducts concurrent and retrospective claim audits to assure adherence to CMS and other… more
- US Tech Solutions (Columbia, SC)
- …behavior change and increase member program engagement. + 20% Performs medical or behavioral review /authorization process. Ensures coverage for appropriate ... + Reviews and evaluates medical or behavioural eligibility regarding benefits and clinical...the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse … more
- Commonwealth of Pennsylvania (PA)
- Registered Nurse Supervisor (3rd Shift) -...and patient support services. As a supervisor, you will review all phases of nursing service, act as a ... Warren State Hospital Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/4933167) Apply Registered Nurse Supervisor (3rd Shift) - Warren… more
- US Tech Solutions (Columbia, SC)
- …+ Utilizes available resources to promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. + Ensures coverage for ... at least 2 years hospital experience, any other utilization review experience is great, different areas of work is...approved or denied. Some may need sent to the medical director. They will also need to be flexible… more
- The County of Los Angeles (Los Angeles, CA)
- …be active and unrestricted. Successful candidates are required to provide proof of their Registered Nurse ( RN ) License and Basic Life Support (BLS) ... REGISTERED NURSE I/RELIEF NURSE ...vaccination against COVID-19 or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates… more
- The County of Los Angeles (Los Angeles, CA)
- REGISTERED NURSE I, SHERIFF (CORRECTIONAL HEALTH) Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2930992) Apply REGISTERED NURSE ... is currently offering up to 20% bonus for full-time Registered Nurse I, Sheriff positions hired by...vaccination against COVID-19 or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates… more
- MyFlorida (Orlando, FL)
- …that all verbal orders, including telephone orders from attending physicians, are reviewed by a registered nurse . + If no RN is available, receive all ... reflective of resident's status, and providing supervision and guidance to the Registered ( RN ), Licensed Practical Nurse (LPN), Certified Nursing… more
- Montana State University-Northern (Havre, MT)
- Clinical Resource Registered Nurse (CRRN) part-time Below you will find the details for the position including any supplementary documentation and questions you ... should review before applying for the opening. To apply for...Details Position Information NBAPOSN Title Working Title Clinical Resource Registered Nurse (CRRN) part-time Brief Position Overview… more
- CVS Health (Delaware, OH)
- …Franklin, Delaware, Madison, Pickaway or Union Counties, Ohio + Must have active and unrestricted Registered Nurse ( RN ) Licensure in the state of Ohio + 2+ ... all case management activities with members to evaluate the medical needs of the member to facilitate the member's...in Nursing **License** + Must have active and unrestricted Registered Nurse ( RN ) Licensure in… more
- Ascension Health (Baltimore, MD)
- …management rules and regulations. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Maryland Board of Nursing ... cases. + Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. +… more