- USAA (Colorado Springs, CO)
- …Minimum of 4 years working with Medicare Supplement claims and/or Medicare -related claims.Expert Advice: Ability to review complicated medical records and ... talented Medical Specialist Principal to play a crucial role in advising the Medicare Supplement Claims Department on the morbidity and claims risk of health… more
- US Tech Solutions (Canton, MA)
- …extension)** Notes: Fully remote, MA license required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that ... / lines of business; such as state specific Medicaid and Senior Products ( Medicare Advantage and SCO).** The Clinical Reviewer ensures consistent and timely… more
- Centers Plan for Healthy Living (Margate, FL)
- …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works ... UM Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063,...to enroll eligible individuals who are either Medicaid or Medicaid/ Medicare recipients and optimize their ability to remain in… more
- SSM Health (MO)
- …Preferred Qualifications: CCDS certification Prior experience as a Second Level Reviewer Prior experience reviewing PSI (patient safety indicator) or experience with ... risk adjustment (mortality) findings. + Maintains knowledge of Centers for Medicare and Medicaid Services (CMS) requirements related to clinical documentation and… more
- Insight Global (Morristown, NJ)
- Job Description The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG reviews ... AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest savings for… more
- Zelis (TX)
- …as required to meet business needs. What you will bring: + Registered Nurse licensure preferred + Inpatient Coding Certification required (ie, CCS, CIC, RHIA, RHIT) ... with providers + Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs + Strong understanding of hospital… more
- Guthrie (Towanda, PA)
- …prevention of patient populations through nursing-patient collaboration and patient education. This nurse performs the Medicare Annual Wellness Visit under the ... Up to a $15,000.00 Sign on Bonus! Summary The Wellness Nurse plays a key role in health promotion and illness… 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 ... administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the largest… more
- Fallon Health (Worcester, MA)
- …necessity, benefit eligibility, and network contract status criteria to a physician reviewer for consideration, ensuring the timely review of the referred ... case + Identifies and refers readmission reviews to a physician reviewer for consideration, ensuring the timely review of the referred case + Incrementally… more
- US Tech Solutions (Chicago, IL)
- …experience with Utilization Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions is a global staff ... clinical policy, regulatory and accreditation guidelines. + Responsible for the review and evaluation of clinical information and documentation. + Reviews… more
- Centene Corporation (Phoenix, AZ)
- …preferred. Knowledge of utilization management processes preferred. NICU concurrent review nurse preferred **License/Certification:** + LPN - Licensed ... care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member... - State Licensure required + RN - Registered Nurse - State Licensure required Pay Range: $26.50 -… more
- US Tech Solutions (May, OK)
- …clinical policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. . Reviews ... Care cases across all lines of business (Commercial and Medicare ). . Independently coordinates the clinical resolution with internal/external.... 1+ years of inpatient hospital experience . Registered Nurse in state of residence . Must have prior… more
- Fallon Health (Worcester, MA)
- …on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review service requests ... necessity, benefit eligibility, and network contract status criteria to a physician reviewer for consideration, ensuring the timely review of the referred… more
- CareOregon (Portland, OR)
- …and implements planned nursing and medical interventions as delegated by registered nurse /clinician. + Perform duties in compliance with Medicare Condition of ... care costs and increase provider/care team satisfaction. Housecall Providers has saved Medicare millions of dollars, while providing better care to our patients,… more
- Hackensack Meridian Health (Maywood, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Registered Nurse Care Manager** is a member of the healthcare team and is responsible for ... **Responsibilities** A day in the life of a **Registered Nurse Care Manager** at **Hackensack Meridian** **_Health_** includes: +...benefits, and Provides Second Important message is provided to Medicare patients 4 to 48 hours prior to discharge.… more
- LA Care Health Plan (Los Angeles, CA)
- …for Centers for Medicare and Medicaid Services (CMS), DMHC, and external review organization (QIO or IRE). Process the case thru to effectuation and final case ... Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department:...in a manner consistent with LA Care, Centers of Medicare and Medicaid Services (CMS) and regulatory guidelines. Benefit… more
- CenterWell (Port Orange, FL)
- **Become a part of our caring community and help us put health first** The Nurse Practitioner (NP) works in our team-based care environment. We are a value based ... team consists of doctors, advanced practice professionals, Pharm D, Care Coach Nurse , MA, Behavioral health specialist, Quality based Coder, Referral Coordinator and… more
- CenterWell (Madison, TN)
- …part of our caring community and help us put health first** The Nurse Practitioner (VSP/PT) applies advanced education and clinical competencies to achieve optimal ... patient outcomes. The Nurse Practitioner (VSP/PT) works on problems of diverse scope...Leadership. . Meets with RMD about quality of care, review of outcome data, policy, procedure, and records issues.… more
- Lowe's (Charlotte, NC)
- …a clinical position. + 3-5 Years of Experience as a Case Manager or Utilization Review Nurse in worker's compensation + Experience in a clinical position + 1-2 ... treatment to an appropriate resolution. Apply medical treatment guidelines for future Medicare -covered expenses. The candidate will work directly for a Fortune 100… more
- Penn Medicine (Lancaster, PA)
- …as defined by the American Nurses Association standards of nursing practice. The Clinical Nurse 1 New to Practice/Apprentice is a newly licensed new to practice RN ... safe practice within the organizational professional practice model. The Clinical Nurse 1 New to Practice/Apprentice seeks guidance to integrate concepts, knowledge,… more
