- Commonwealth Care Alliance (Boston, MA)
- …claims adjudication, clinical coding reviews for claims , settlement, claims auditing and/or utilization review required + 7+ years experience with ... Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical coding and reimbursement...regulations. The role will also be responsible for timely review and research, as necessary on all new and… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …(eg, MSK leadership, its captive insurance program, and excess insurance carriers) on clinical risk and claims issues and will support and guide patient ... our mission at MSK and around the globe. Please review important announcements about vaccination requirements and our upcoming...of Risk Management experience in a hospital setting. + RN or other clinical experience preferred. +… more
- MetLife (Cary, NC)
- …resource on clinical and technical issues. * Conducts complex research, review and analysis of medical records, treatment plans and claim information. * Provides ... Microsoft, Teams, OneNote * Strong written/verbal communication. * Current RN licensure * 4+ years of experience as an... Preferred * BSN * 7+ years of Disability claims and/or clinical experience. * Disability … more
- US Tech Solutions (Columbia, SC)
- …to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of ... of care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance… more
- The Hartford (Alpharetta, GA)
- …Alpharetta, GA) that will perform Utilization Review for Work ers' Compensation Claims . An Initial Clinical Reviewer (ICR) is responsible for evaluating ... The Clinical team is seeking an Initial Clinical Reviewer . This is a 100% in...This position will also be cross trained in Drug Review . Qualifications: + RN / Nurse… 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 + ... audits within Care Transformation operations by supporting the Clinical Documentation Improvement, Utilization Management, Status Review ,...Registered Nurse ( RN ) - Missouri Division of Professional… more
- 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 + ... Waupun and Ripon locations, completing vitals, medication management, insurance claims and nursing assessments when needed.** **Benefits** Medical, Dental,...Registered Nurse ( RN ) - Missouri Division of Professional… more
- Sedgwick (Columbus, OH)
- …the need for absence from work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and ... completes medical review of all claims to ensure information substantiates disability. + Provides clear and appropriate follow-up recommendations for ongoing… more
- Access Dubuque (Dubuque, IA)
- …the need for absence from work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and ... Disability Clinical Specialist **Sedgwick** 1 Positions ID: R54336 Posted...completes medical review of all claims to ensure information substantiates disability. + Provides clear… more
- R1 RCM (Chicago, IL)
- …AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review...external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + **Active AHIMA or… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …to 10% of employed time in QA activities. Essential Qualifications + Currently licensed Registered Nurse ( RN ) + Must maintain current licensure(s) and ... Health and Workers' Compensation and other Casualty clients. The Workers' Compensation Nurse Case Reviewer collaborates with medical care providers, employers,… more
- Zelis (TX)
- …to Zelis standards regarding privacy Skills, Knowledge, and Experience: + Registered Nurse licensure preferred + Inpatient Coding Certification required ... Position Overview: The Inpatient DRG Reviewer will be primarily responsible for conducting post-service,...choices of new codes and DRG, based on the clinical evidence obtained during the review +… more
- Zelis (Morristown, NJ)
- Position Overview: The Nurse Reviewer is primarily responsible for conducting post-service, pre or post payment in-depth claim reviews based on accepted medical ... guidelines and clinical criteria, billing and coding rules, plan policy exclusions,...provider preferred. + 2+ years of auditing or performing claims review in specialty pharmacy claims… 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...medical specialty and subspecialty. In addition to its direct clinical services, DHS also runs the Emergency Medical Services… more
- US Tech Solutions (Columbia, SC)
- …to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of ... Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication....the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse … more
- US Tech Solutions (Columbia, SC)
- …decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. + May provide any of ... individual patient's benefits contract and our medical policies. The nurse would read through clinical information, ensuring...the following in support of medical claims review and utilization review … more
- ManpowerGroup (Columbia, SC)
- …service requests or provides health management program interventions. + Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of ... etc.). + Participates in data collection/input into system for clinical information flow and proper claims adjudication....the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse … more
- Trinity Health (Syracuse, NY)
- …appropriate discharge plan for the patients within their service area. The Registered Nurse Manager is accountable for applying positive managerial strategies ... for physicians and hospital departments as needed. + Applies clinical experience, health plan benefit, structure, and claims...accredited School of Nursing and current licensure as a Registered Nurse in New York State. +… more
- Sutter Health (San Francisco, CA)
- …Master in nursing, case management or related field. **CERTIFICATION & LICENSURE** + RN - Registered Nurse of California (required) + CCM-Certified Case ... team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and… 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:** ... team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and… more