- 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
- Banner Health (AZ)
- …damage claims , such as lien information. Submits necessary information to consultant/ expert for review . Collaborates with Claims Directors regarding ... focused on enhancing processes and maximizing efficiency with the review and management of claims and litigation...well as a part of a team. PREFERRED QUALIFICATIONS Registered nurse with active licensure with clinical… more
- Blue KC (MO)
- …of URAC and NCQA(R) guidelines and state and federal regulations. + Valid and active Registered nurse ( RN ) in Missouri and Kansas. + Valid and active ... + Ensures proper payment of pre-transplant, transplant, and post-transplant claims . Sets up transplant pre-pay review for... Registered nurse ( RN ) licensure in… more
- Public Consulting Group (Council Bluffs, IA)
- …+ Ability to successfully monitor and ensure the quality of data analytic and clinical review activities. + Knowledge of claims and medical record review ... for coordinating program integrity-related reviews with the medical necessity review team responsible for conducting medical necessity reviews, ensuring services… more
- Tufts Medicine (Boston, MA)
- …patient harm. **Job Description** **Minimum Qualifications** **:** 1. Bachelor's degree in Nursing 2. Registered Nurse ( RN ) license. 3. Five (5) years of ... specialist level role that is a recognized subject matter expert in job area typically obtained through advanced education...requested. 13. Collaborates with Office of General Counsel and Claims departments in order to review and… more
- Houston Methodist (Sugar Land, TX)
- …assigned patient population, under the direct supervision of a Physician, APP and/or Registered Nurse . This position oversees appropriate scope of practice, (ie ... of patient care and services, while functioning as an expert and demonstrating highly competent knowledge in the more...the clinic under the direct supervision of a Physician, Registered Nurse , or clinic leadership procedures, using… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …services **Required Licensure and Certifications:** Current unrestricted licensure as a Registered Nurse in the state of Washington National certification ... you will find the safest and highest quality of care provided by our expert , compassionate medical care team at 11 hospitals and nearly 300 sites throughout the… more
- R1 RCM (Salt Lake City, UT)
- …appeals.Represent clients at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay ... will help our hospital clients by serving as an expert on appeals and denials management where claims...what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of… more
- Commonwealth Care Alliance (Boston, MA)
- …Yes **What You'll Be Doing:** + Function as the IT subject matter expert for Ancillary & Pharmacy integrations, platforms, and tools. + Collaborate with IT ... and deliver business outcomes. + Consult with business unit's and review IT usage, services, technology, and department specific projects. Identify, forecast… more