- SSM Health (Waupun, WI)
- …Illinois Department of Financial and Professional Regulation (IDFPR) State of Work Location: Missouri + Registered Nurse ( RN ) Issued by Compact State + Or + ... NP for Waupun and Ripon locations, completing vitals, medication management , insurance claims and nursing assessments when...Registered Nurse ( RN ) - Missouri Division of Professional… more
- Elevance Health (Columbus, OH)
- …review . **How you will make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with developing unit goals, ... ** RN Hospital Bill Audit/Appeal Lead** **Supports the Carelon...and/or fraudulent activities by health care providers through prepayment claims review , post payment auditing, and provider… more
- Sutter Health (San Francisco, CA)
- …in nursing, case management or related field. **CERTIFICATION & LICENSURE** + RN - Registered Nurse of California (required) + CCM-Certified Case Manager ... nursing management , quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted… more
- Trinity Health (Syracuse, NY)
- …benefit, structure, and claims payment knowledge to pre and post service review . + Analyzes utilization management trends. + Unit and organizational quality ... Joseph's Health Mission and Values, the manager of Utilization Review is responsible for the planning, and coordination of...plan for the patients within their service area. The Registered Nurse Manager is accountable for applying… more
- Veterans Affairs, Veterans Health Administration (Fayetteville, AR)
- Summary Veterans Healthcare Systems of the Ozarks is seeking to hire a Registered Nurse that is a clinical expert and executes position responsibilities that ... such as the Joint Patient Safety Reporting (JPSR), Tort Claims , and Peer Review . Supports all QM...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Sutter Health (San Francisco, CA)
- …**EDUCATION:** Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** RN - Registered Nurse of California Upon Hire **TYPICAL EXPERIENCE:** ... nursing management , quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted… more
- Sutter Health (San Francisco, CA)
- …**EDUCATION:** Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** RN - Registered Nurse of California Upon Hire **TYPICAL EXPERIENCE:** ... nursing management , quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted… more
- Sutter Health (Sacramento, CA)
- …school of nursing + Bachelor's in Nursing preferred. **CERTIFICATION & LICENSURE:** + RN - Registered Nurse of California Upon Hire **TYPICAL EXPERIENCE:** + ... nursing management , quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted… more
- Veterans Affairs, Veterans Health Administration (San Diego, CA)
- …equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion ... for developing and managing the VA San Diego Healthcare System (VASDHS) Risk Management Program that supports the mission, vision and core values in accordance with… more
- US Tech Solutions (Columbia, SC)
- …providing telephonic case management for our members. + Past job instability. Registered nurses MUST have 4 years or more of RECENT clinical experience. + Strong ... established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis,… more
- SSM Health (St. Louis, MO)
- …Illinois Department of Financial and Professional Regulation (IDFPR) State of Work Location: Missouri + Registered Nurse ( RN ) Issued by Compact State + Or + ... Transformation operations by supporting the Clinical Documentation Improvement, Utilization Management , Status Review , and Case Management...Registered Nurse ( RN ) - Missouri Division of Professional… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …RN Clinical Provider Post Service Review Manager , led by a Registered Nurse , is responsible for a team of provider correspondence associates who research ... with all levels of the organization Education/Relevant Experience: + Active professional Registered Nurse in MA required. Bachelor's degree preferred +… more
- AdventHealth (Altamonte Springs, FL)
- …you'll contribute:** The role of the Emergency Department Utilization Management (UM) Registered Nurse ( RN ) is to use clinical expertise by analyzing ... review as determined by department standards. The Utilization Management Nurse is accountable for a designated.... Current and valid license to practice as a Registered Nurse (ADN or BSN) required. .… more
- Commonwealth Care Alliance (Boston, MA)
- …Payment Integrity and Analytics + Direct and relevant experience with HCFA/UB-04 claims management , coding rules and guidelines, and evaluating/analyzing claim ... Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical ...adjudication, clinical coding reviews for claims , settlement, claims auditing and/or utilization review required +… more
- Molina Healthcare (Lexington, KY)
- …& ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of ... experience in Claims Auditing, Medical Necessity Review and Coding experience + Familiar with state/federal regulations **REQUIRED LICENSE, CERTIFICATION,… more
- Humana (Columbus, OH)
- …to make an impact** **Required Qualifications** + Minimum of Associate Degree in Nursing + Registered Nurse ( RN ) licensure with no disciplinary action. + ... Complete medical record reviews + Assess discharge plans + Review and extract information from claims +...Registered nurse with Compact Licensure (licensed and located in compact… more
- AdventHealth (Shawnee, KS)
- …and experiences you'll need to succeed:** _Required:_ + Bachelor's Degree + Kansas Registered Nurse License + 2 to 5 Years of Position-Related Experience ... several risk mitigation programs. Manages all enterprise risk insurance claims in collaboration w/ AHS Risk Management ..._Preferred_ + Certified Professional in Healthcare Risk Management (CPHRM) _Preferred_ _Preferred:_ + RN with… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II...on case reviews for pre-service, concurrent, post-service and retrospective claims medical review . Monitors and oversees the… more
- HCA Healthcare (Thornton, CO)
- …qualifications you will need:** + Current licensure in the State of Colorado as a Registered Nurse , or current active multistate Registered Nurse ... typical candidate is hired below midpoint of the range. ** RN Case Manager PRN** **Weekday, Weekend and Holiday Availability...2-4 shifts for 3 weeks during weekday** **Medical Case Management with Discharge Planning** Do you want to be… more
- AdventHealth (Shawnee, KS)
- …+ Bachelor's Degree + 1 to 2 Years of Position-Related Experience + Kansas Registered Nurse License + 2 to 5 Years of Position-Related Experience _Preferred_ ... as coordination of several risk mitigation programs. Manages all enterprise risk insurance claims in collaboration w/ AHS Risk Management eg general and… more