- CareFirst (Cumberland, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and ... claim is eligible for benefits and to support claims processing and/or adjudication. The incumbent will handle pre...and/or adjudication. The incumbent will handle pre and post claim medical review for Commercial,… more
- Rising Medical Solutions (Chicago, IL)
- …With offices, providers, and case managers nationwide, RISING provides comprehensive medical claims solutions to our valued clients: insurance carriers, ... business was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse ...in acute care, surgery and/or orthopedic + Workers' Compensation medical bill review experience a major plus… more
- Medical Mutual of Ohio (OH)
- …the continuum of care. **Responsibilities** + Independently evaluates basic to complex medical claims and/or appeal cases and associated records by applying ... stay and level of care + Extrapolates and summarizes medical information for physician review or other...degree preferred + 3 years' experience as a Registered Nurse in acute care, critical care, emergency medical… more
- Travelers Insurance Company (Diamond Bar, CA)
- …Utilizes evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... negotiating and resolving assigned General Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim … more
- Robert Half Accountemps (New Haven, CT)
- …of workers compensation lost time claims from set-up to case closure * Review claim and policy information to provide background for investigation * Conduct ... and indemnity benefits throughout the life of the claim * Review the claim ...initiatives * Comply with customer service requests including Special Claims Handling procedures, file status notes, and claim… more
- Metropolitan Council (St. Paul, MN)
- …+ Participate in bi-annual claims meetings with internal departments. + Review medical , legal, and miscellaneous invoices to determine if reasonable and ... to our organization and the Twin Cities region: TheWorkers' Compensation Claims Representativewill administer Minnesota lost time and medical -only Workers'… more
- Travelers Insurance Company (Albany, NY)
- …Network per jurisdictional guidelines. + Research medical information to support the claim review process. + Occasional contact with provider to ensure the ... you do and where you do it. **Job Category** Claim , Nurse - Medical Case...Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity… more
- Access Dubuque (Dubuque, IA)
- Claims Processing Representative **Grand River Medical Group** 1 Positions ID: 1343279 Posted On 10/30/2024 **Job Overview** ** Claims Processing ... Position located in Dubuque, IA; telecommuting options available Grand River Medical Group is seeking an experienced Claims Processing Representative… 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 ...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- The Arora Group (Bethesda, MD)
- Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in Bethesda, ... required on Federal holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW : + Initiate,...clinical information and may also provide education on the medical review process. + The Contractor performing… 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 ... healthcare needs of our members. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying… more
- Commonwealth of Pennsylvania (PA)
- …I have professional experience performing this Work Behavior as a charge nurse , head nurse , utilization review nurse , quality assurance nurse , or an ... nursing care and treatment process to ensure compliance with medical , psychiatric, and nursing protocols, as well as maintain...Work Behavior as a charge nurse , head nurse , utilization review nurse , quality… more
- Commonwealth of Pennsylvania (PA)
- Health Care Nurse Surveyor Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/4725727) Apply Health Care Nurse Surveyor Salary $66,250.00 - ... receive proper care? The Department of Health is seeking a motivated Health Care Nurse Surveyor. If you like to work independently, but also collaborate with other… more
- Veterans Affairs, Veterans Health Administration (San Diego, CA)
- …at a wide variety of audiences; demonstrates proficiency in reviewing and processing medical malpractice claims , medical advisory opinions, and expert ... education sessions, conferences and workshops. Provides advice and support to the medical center staff, directs the development and maintenance of programs designed… more
- NJM Insurance (Trenton, NJ)
- …Auto (PIP/Medpay) lines of business by performing prospective and retrospective Utilization Review of medical services/treatment requested or rendered by ... and/or evidence-based guidelines. Job Responsibilities: + Accurately and effectively evaluate the claim history and current medical records against NJM … more
- Ventura County (Ventura, CA)
- Senior Medical Management Nurse - VCHCP Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4591361) Apply Senior Medical Management ... to County employees and their covered dependents. The Senior Registered Nurse -Ambulatory Care series is distinguished from other nursing classifications in that… more
- State of Georgia (Fulton County, GA)
- …additional experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT codes ... Nurse Investigator Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/51086/other-jobs-matching/location-only)...clinical experience AND one (1) year experience working with medical claims . Preference will be given to… more
- City and County of San Francisco (San Francisco, CA)
- …Program (CCHP) * Child Health and Disability Prevention Program (CHDP) * Children's Medical Services (CMS) * Director of Public Health Nursing * Family and ... Children's Services (FCS) Public Health Nurse (PHN) Unit * Field Home Visiting/ Nurse Family Partnership (NFP) Program The list resulting from this recruitment… more
- Elevance Health (Tampa, FL)
- Job Description ** Nurse Medical Management Sr.** **Preferred Location** : Florida. **This position will work 100% remote (with the exception of team meetings ... miles of one of our Elevance Health PulsePoint locations. ** Nurse Medical Management Sr.** Responsible to serves... directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied.… more
- Elevance Health (St. Louis, MO)
- ** Nurse Medical Management Sr.** At **Federal Health Products and Services - FHPS** , a proud member of the Elevance Health, Inc. family of companies, it's a ... 7 pm (EST) shift rotation twice a month.** The ** Nurse Medical Management Sr** is responsible for...directors to interpret the appropriateness of care and accurate claims payment. May also manage appeals for services denied.… more