• Clinical Medical Review Nurse

    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
    CareFirst (11/15/24)
    - Save Job - Related Jobs - Block Source
  • Nurse Auditor - Medical Bill…

    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
    Rising Medical Solutions (11/13/24)
    - Save Job - Related Jobs - Block Source
  • Registered Nurse Clinical Appeal…

    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
    Medical Mutual of Ohio (11/15/24)
    - Save Job - Related Jobs - Block Source
  • Senior Commercial General Liability Claim

    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
    Travelers Insurance Company (11/09/24)
    - Save Job - Related Jobs - Block Source
  • Claims Examiner-Lost Time

    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
    Robert Half Accountemps (10/25/24)
    - Save Job - Related Jobs - Block Source
  • Workers' Compensation Claims Representative…

    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
    Metropolitan Council (10/24/24)
    - Save Job - Related Jobs - Block Source
  • Utilization Review Nurse - Workers'…

    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
    Travelers Insurance Company (11/21/24)
    - Save Job - Related Jobs - Block Source
  • Claims Processing Representative

    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
    Access Dubuque (10/31/24)
    - Save Job - Related Jobs - Block Source
  • Utilization Review Nurse Supervisor…

    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 County of Los Angeles (09/30/24)
    - Save Job - Related Jobs - Block Source
  • Licensed Practical Nurse (LPN)…

    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
    The Arora Group (11/22/24)
    - Save Job - Related Jobs - Block Source
  • Utilization Review Nurse

    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
    US Tech Solutions (10/31/24)
    - Save Job - Related Jobs - Block Source
  • Nurse Manager 1 - Danville State Hospital…

    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 (11/21/24)
    - Save Job - Related Jobs - Block Source
  • Health Care Nurse Surveyor

    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
    Commonwealth of Pennsylvania (11/25/24)
    - Save Job - Related Jobs - Block Source
  • Registered Nurse Risk Manager

    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
    Veterans Affairs, Veterans Health Administration (11/10/24)
    - Save Job - Related Jobs - Block Source
  • Precertification Nurse

    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
    NJM Insurance (11/06/24)
    - Save Job - Related Jobs - Block Source
  • Senior Medical Management Nurse

    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
    Ventura County (11/12/24)
    - Save Job - Related Jobs - Block Source
  • Nurse Investigator

    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
    State of Georgia (09/20/24)
    - Save Job - Related Jobs - Block Source
  • Nurse Manager - DPH - Maternal, Child,…

    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
    City and County of San Francisco (11/14/24)
    - Save Job - Related Jobs - Block Source
  • Nurse Medical Management Sr

    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 (11/25/24)
    - Save Job - Related Jobs - Block Source
  • Nurse Medical Mgmt Sr

    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
    Elevance Health (11/22/24)
    - Save Job - Related Jobs - Block Source