- 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
- 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
- Guardian Life (Columbus, OH)
- … or rehab evaluation **Partnering** + Proactively communicates with client companies to review case management and claims experience + Consult with Risk ... at what they do. **Position Objective** : The FML Claims Case Manager II is responsible for proactively managing...interacts and consults with key partners including: Clients, Claimants, Nurse and Disability Case Managers, Risk Management. The FML… more
- Access Dubuque (Dubuque, IA)
- Claims Processing Representative **Grand River Medical Group** 1 Positions ID: 1384666 Posted On 12/23/2024 **Job Overview** ** Claims Processing ... Position located in Dubuque, IA; telecommuting options available Grand River Medical Group is seeking an experienced Claims Processing Representative… more
- 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
- Morley (CA)
- …case details? If so, this role could be a perfect fit for you! As a Legal Claims Analyst at Morley, you'll play a key role in managing small automotive claims ... to support the client's defense strategies, including lemon law claims . + Serve as the "Person Most Knowledgeable" (PMK)...the time. + Work in partnership with the California review team (located in Michigan), evaluating vehicle buyback requests… more
- 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
- Martin's Point Health Care (Portland, ME)
- …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...for medical necessity reviews. + Manage the review of medical claims disputes,… more
- Defense Health Agency (Fort Sam Houston, TX)
- …for arranging, scheduling, and coordinating interview of MEDCEN personnel by the Medical Claims Judge Advocate, Department of Justice or representatives of ... review , referral to an appropriate committee, a Serious Medical Incident Report to the US Army Medical.... Upon receipt of a copy of a malpractice claim , reviews the medical records to identify… more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- … medical treatment facility, in rehabilitative or occupational nursing or providing medical review of insurance claims . MINIMUM QUALIFICATIONS - ... Utilization Review Nurse (40 Hour) Office/On-site Recruitment...party administrator files to oversee contractor handling; + May review medical records of various health care… more
- 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
- Ascension Health (Wamego, KS)
- …cases. + Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals. + ... health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests within assigned… more
- Lincoln Financial Group (Columbus, OH)
- …organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you ... a clinical resource for Group Protection benefit specialists and claim professionals. You will evaluate medical information...this role you will provide coaching and guidance to claims regarding medical management **What you'll be… 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 ... early intervention, return to work planning, coordination of quality medical care on claims involving disability and...for ensuring that employees receive appropriate treatment and/or assist claim examiners in managing medical treatment to… more
- 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
- TEKsystems (Chesapeake, VA)
- …documentation + Assigning modifiers to appropriate claims + Researching edited claims for medical necessity, and advising the billing staff of appropriate ... record and other applicable hospital documentation, assigning modifiers to appropriate claims , researching edited claims for medical necessity, and… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- … record and other applicable hospital documentation, assigning modifiers to appropriate claims , researching edited claims for medical necessity, and ... Job Summary With direction from the Director, the Nurse Auditor/Revenue Integrity Specialist is responsible for auditing itemized charges versus the patient … more
- 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
- MyFlorida (Orlando, FL)
- SENIOR REGISTERED NURSE SUPV Date: Jan 6, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 844110 Agency: Veterans Affairs Working Title: SENIOR REGISTERED NURSE SUPV Pay Plan: Career Service Position Number: 50556022 Salary: 70,699.20… more
- Montana State University (Bozeman, MT)
- …services across sub-units. + Collaborates with Student Health Services Director and Chief Medical Officer to review and adjust staffing to meet fluctuating ... this position, please contact: Whitney Milhoan ### ###@montana.edu Classification Title Registered Nurse /Clinic Mgr - BZ Working Title Nurse Manager Brief… more
Related Job Searches:
Claim,
Medical,
Medical Claim,
Medical Claim Review,
Nurse,
Review,
Review Nurse