- US Tech Solutions, Inc. (Columbia, SC)
- …. Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits ... Job Title: Licensed Practical Nurse Location: Columbia, SC 29219 Duration: 06 months...sets/qualities: I would love to have someone with prior insurance/ utilization review experience but I know that is not… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …organizational standardization. Participates in identifying expanded use of and improvement management utilization of NGHS continuum. Participates in identifying ... Job Category:Nursing - Registered Nurse Work Shift/Schedule:VariesNortheast Georgia Health System is rooted...day operations of the department by supporting the case management and interdisciplinary healthcare team in facilitating patient care… more
- A-Line Staffing Solutions (San Antonio, TX)
- …InterQual, ICD-10, Medical Coding, BSN, Medical Management , Utilization Review, Utilization Management , Registered Nurse , MCO, RN, Nurse , Managed ... Full time Case Manager Nurse RN openings in the San Antonio, TX... experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care.… more
- A-Line Staffing Solutions (Dallas, TX)
- …InterQual, ICD-10, Medical Coding, BSN, Medical Management , Utilization Review, Utilization Management , Registered Nurse , MCO, RN, Nurse , Managed ... Full time Case Manager Nurse RN openings in the Dallas, TX 75244...Management , Home Healthcare, Homecare, Home Health, Home Health Nurse , Home Health Case Manager, RN Case Manager, RN… more
- A-Line Staffing Solutions (Shaker Heights, OH)
- …Case Manager, Medical Coding, BSN, Medical Management , Utilization Review, Utilization Management , Waiver Program, Registered Nurse , MCO, RN, ... BSN, Medical Management , Utilization Review, Utilization Management , Registered Nurse , MCO,... Management , Registered Nurse , MCO, RN, Nurse , Managed Care, Medical Claims, Appeals , Mail… more
- A-Line Staffing Solutions (Tampa, FL)
- …Case Manager, Medical Coding, BSN, Medical Management , Utilization Review, Utilization Management , Registered Nurse , MCO, RN, HMO, Concurrent Review, ... of acute care Assist member with filing and resolving complaints and appeals . Required Experience: Bachelor's degree in human services related field; Including but… more
- A-Line Staffing Solutions (Haverhill, FL)
- …Case Manager, Medical Coding, BSN, Medical Management , Utilization Review, Utilization Management , Registered Nurse , MCO, RN, HMO, Concurrent Review, ... Public Admin, Social Science, Social Work, Sociology) 2+ years of Care Management experience Experience with electronic medical health records, and Microsoft office… more
- Kepro (Indianapolis, IN)
- …vital partner for health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our ... growing team. Job Summary: Our Utilization Management Appeals Nurse - LPN/RN will help orchestrate the seamless resolution of appeals in line with… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Role BHPS provides Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical ... DME, and Complex Care Needs. Essential Qualifications + Current licensed Registered Nurse (RN) with state licensure. Must retain active and unrestricted licensure… more
- LA Care Health Plan (Los Angeles, CA)
- …and Medicaid Services(CMS), external review organization (QIO or IRE). Work with Utilization Management and PNO to facilitate completion of resolution ... Customer Solution Center Appeals and Grievances Nurse Specialist LVN...Care Health Plan members under the direct supervision and management of the A&G Nurse Specialist, RN… more
- Centene Corporation (New York, NY)
- …clinical nursing experience. Proficient with Microsoft Office applications. Experience with utilization or appeals review preferred. Knowledge of InterQual ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Trinity Health (Farmington Hills, MI)
- …regulations, healthcare financing and managed care. Knowledge of and experience in case management and utilization management . Knowledge of insurance and ... rejection, denial and appeal activities with Ministry Organization (MO) based Utilization Review/Case Management departments; + Reviews and understands … more
- LA Care Health Plan (Los Angeles, CA)
- …Skills Required: Knowledge of state, federal and regulatory requirements in Appeals /Care/Case/ Utilization Management /Quality. Strong verbal and written ... Supervisor, Appeals and Grievances Clinical Operations RN Job Category:...a lead/supervisory experience. Equivalency: Completion of the LA Care Management Certificate Training Program may substitute for the supervisory/… more
- Centene Corporation (Sacramento, CA)
- …Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- CareFirst (Baltimore, MD)
- …**Knowledge, Skills and Abilities (KSAs)** + Knowledge of NCQA requirements of utilization review, Case Management standards and guidelines, appeal rights and ... of the Clinical Medical Claims Review, Medical Underwriting, Medical Policy, Clinical Appeals and Analysis programs and Quality of Care Complaint Unit. May lead… more
- Penn Medicine (Philadelphia, PA)
- … appeals correspondence. + Maintains database for the department and the utilization management requirements for the hospital information system and within ... Clinical Appeals Coordinator in all phases of the Clinical Quality and Utilization Management functions including but not limited to data entry, obtaining… more
- Trinity Health (Farmington Hills, MI)
- …in the timeliest manner possible: + Coordinates follow-up activities with Utilization Review/Case Management /Coding/ Nurse Liaison to provide required ... as part of the payment resolution team that receives, analyzes, and appeals denials received for an assigned PBS location. Reviews, researches and resolves… more
- Trinity Health (Farmington Hills, MI)
- …in the timeliest manner possible: + Coordinates follow-up activities with Utilization Review/Case Management /Coding/ Nurse Liaison to provide required ... knowledge of state/federal laws as they relate to contracts and the appeals process. Assists in training Payment Resolution Specialist I colleagues upon hire… more
- Integra Partners (Troy, MI)
- …experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a ... Medical Director to perform benefit and medical necessity reviews and appeals within an NCQA-compliant UM program. Salary: $60,000.00/annual JOB QUALIFICATIONS:… more
- McLaren Health Care (Detroit, MI)
- **Department: Utilization Management ** **Daily Work Times: 9:00am-5:30pm** **Shift: Days** **Scheduled Bi-Weekly Hours: 80** Position Summary: Responsible for ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
