- 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 ... draft appeals of denied and underpaid claims . Every day you will review medical...position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review… more
- Indian Health Service (Kayenta, AZ)
- …the Inpatient Supervisory Nurse . Responsibilities This position is the Nurse ( Clinical Accountability & Metrics), Discharge Planner position. Discharge ... agencies involved in the patient care plans. Works closely with the Utilization Review Coordinator and Contract Health staff for necessary follow-up on claims … more
- R1 RCM (Salt Lake City, UT)
- …position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical records and payer ... encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help our hospital… more
- Molina Healthcare (Lexington, KY)
- …+ Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience ... identified by the Payment Integrity analytical team; requires decision making pertinent to clinical experience + Documents clinical review summaries, bill… more
- 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
- 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 ... *RESPONSIBILITIES:* * Gathers information from patients, clients/family members, HCMC clinical areas, government agencies, employers, third party payors, and/or… 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 ... in nearly every medical specialty and subspecialty. In addition to its direct clinical services, DHS also runs the Emergency Medical Services (EMS) Agency and the… 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
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …provider call center, provider correspondence and appeals, clinical review , member correspondence and reconsiderations, enrollment, claims processing, ... Summary: The RN Clinical Provider Post Service Review Manager , led by a Registered Nurse...by the FEP Association to ensure compliance and accurate case/ claims processing This leader must demonstrate the attributes and… 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. ... maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee...neuro, rehab, or ER procedures + 3-5 years of clinical experience in acute care, surgery and/or orthopedic +… 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
- GEHA (Lee's Summit, MO)
- …of open gaps in care, education of the member on how to close those gaps, review of clinical history, and review of member's treatment plan against ... contact and/or clinical and/or plan policy development and management. The Nurse Consultant II will be involved in research and development for policies and… more
- CareFirst (Baltimore, MD)
- …reduction of and/or recuperation of losses to CareFirst through the clinical review of medical records and claims , resulting in the savings and/or recovery ... to support both prepayment reviews and/or post-payment investigations. **ESSENTIAL FUNCTIONS:** + Review of medical records and claims . + Investigate potential… 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
- 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
- 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
- Trinity Health (Syracuse, NY)
- …Develops education for physicians and hospital departments as needed. + Applies clinical experience, health plan benefit, structure, and claims payment knowledge ... Abiding by the St. Joseph's Health Mission and Values, the manager of Utilization Review is responsible for the planning, and coordination of utilization review … more
- CVS Health (Charleston, WV)
- …and conduct reviews **Preferred Qualifications** + Experience with ASD, MedCompass, IOP, or clinical review experience with therapy review types + Experience ... to 5pm EST time zone where the candidate resides. **.** Responsible for the review and evaluation of clinical information and documentation related to outpatient… more
- Lowe's (Charlotte, NC)
- … clinical position. + 3-5 Years of Experience as a Case Manager or Utilization Review Nurse in worker's compensation + Experience in a clinical position + ... return to work planning, coordination of quality medical care on claims involving disability and medical treatment. Assessment and intervention, including… more