- Martin's Point Health Care (Portland, ME)
- …and performs medical necessity reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate ... Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of...internal guidelines for medical necessity reviews. + Manage the review of medical claims disputes, records, and… more
- Metropolitan Council (St. Paul, MN)
- …leave. + Investigate and pursue subrogation, as appropriate. + Participate in bi-annual claims meetings with internal departments. + Review medical, legal, and ... Workers' Compensation Claims Representative II - REPOST Print (https://www.governmentjobs.com/careers/metrocouncil/jobs/newprint/4511198) Apply...Benefits + Questions WHO WE ARE We will NOT review resumes or cover letters for this position, so… more
- Lincoln Financial Group (Columbus, OH)
- …a Glance** We are excited to bring on a highly motivated Integrated Absence Claims Specialist to staff our ever-growing claims organization. As an Integrated ... Claims Specialist, you will manage a workload of Short-Term Disability claims and their associated leaves. You will be responsible for conducting initial and… more
- Lincoln Financial Group (Columbus, OH)
- …a Glance** We are excited to bring on a highly motivated Long-Term Disability (LTD) Claims Specialist to our claims organization. **What you'll be doing** As an ... LTD Claims Specialist, you will manage a workload of Long-Term...benefits when applicable. * Collaborating with fellow case managers, nurse case managers, vocational case managers, and consulting physicians… more
- Lincoln Financial Group (Columbus, OH)
- …Role at a Glance** We are excited to bring on a highly motivated **Group Claims Specialist** to support our ever-growing claims organization in a work from home ... to support our west coast employer groups. _Background details_ As a Group Claims Specialist, you will support our Short Term Disability or Integrated Absence teams.… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *SUMMARY:* We are currently seeking an*RCM Representative Senior*to join our*Third-Party Claims - HB & PB *team. This full-time role will primarily work remotely ... service and timely response to questions and issues related to benefits, billing, claims , payments, etc. * Answers questions (by phone and in-person) and provides… 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
- 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 Center, one...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- Staffing Solutions Organization (Augusta, ME)
- Registered Nurse - Authorization Review Augusta, ME 04330, USA Req #964 Monday, July 29, 2024 Staffing Solutions Organization LLC (SSO), an affiliate of Public ... of our clients and the people they serve. **Registered Nurse - Authorization Review Unit - MaineCare...PAs. + Collaborate with other OMS units to resolve claims issues that involve PAs. + Respond to questions… more
- The Cigna Group (Bloomfield, CT)
- …addressed properly and accurately; e) prepare case files for submission to Independent Review Entity, which also include writing required case summary on behalf of ... and organizational skills; effectively manage competing priorities and multiple deadlines. + Review , research and understand how request for plan services and … more
- Travelers Insurance Company (Buffalo, NY)
- …Imagine loving what you do and where you do it. **Job Category** Claim, Nurse - Medical Case Manager **Compensation Overview** The annual base salary range provided ... Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for prospective, concurrent,… more
- Rising Medical Solutions (Chicago, IL)
- …was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark in the world of medical cost containment. ... team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance,… more
- Intermountain Health (Murray, UT)
- …etc.) + Reviews outpatient pre-authorization requests and/or retrospective requests through claims review and incoming requests through fax, electronic ... coordination of transition of care and manage utilization through appropriate review of authorization requests. Job Essentials + Analyzes and evaluates medical… more
- Veterans Affairs, Veterans Health Administration (Chicago, IL)
- …Investigations including reporting/tracking and implementation of recommendations; Management Review and Improvement; performance measures; Tort Claims ... Summary The Jesse Brown VA Medical Center Registered Nurse (RN) - Risk Manager is responsible for...management program that helps to avoid or reduce liability claims through identification of potential risk/s and takes action… more
- CareFirst (Baltimore, MD)
- …prevention, reduction of and/or recuperation of losses to CareFirst through the clinical review of medical records and claims , resulting in the savings and/or ... to support both prepayment reviews and/or post-payment investigations. **ESSENTIAL FUNCTIONS:** + Review of medical records and claims . + Investigate potential… more
- State of Georgia (Fulton County, GA)
- …Specific, additional experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT ... Nurse Investigator Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/51086/other-jobs-matching/location-only) Hot… more
- Zelis (Morristown, NJ)
- …a health care organization or provider preferred. + 2+ years of auditing or performing claims review in specialty pharmacy claims or specialty drugs + Strong ... Position Overview: The Nurse Reviewer is primarily responsible for conducting post-service,...financial negotiation with providers + 3-5 years of auditing, claims , review and/or billing experience with a… more
- GEHA (Lee's Summit, MO)
- …personalized customer experience, sustained by a nimble and efficient organization. The Nurse Consultant II provides professional nursing care to our members through ... of the member on how to close those gaps, review of clinical history, and review of...and/or clinical and/or plan policy development and management. The Nurse Consultant II will be involved in research and… more
- State of Massachusetts (Boston, MA)
- …Department of Children and Families (DCF) is seeking an experienced, dedicated, and licensed nurse to fill the role of *Registered Nurse for the Boston Regional ... support the social work teams. Based in the Boston Region Office the nurse will help implement healthcare-related agency policy and provide consultation to internal… more
- Ventura County (Ventura, CA)
- Senior Medical Management Nurse - VCHCP Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4591361) Apply Senior Medical Management Nurse - ... to County employees and their covered dependents. The Senior Registered Nurse -Ambulatory Care series is distinguished from other nursing classifications in that… more
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