- 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 in ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...Claims Auditing, Medical Necessity Review and Coding experience +… more
- 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
- Travelers Insurance Company (Irvine, 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 (Melville, NY)
- …law in conjunction with Claim counsel and First Party Medical claim professional, if necessary. Proactively manage ongoing litigation/arbitration through ... **What Is the Opportunity?** This position handles First Party Medical Litigation or Arbitration claims from the...facts necessary to determine defensibility and potential exposure. Prompt review of claim file and handling procedures… more
- Travelers Insurance Company (St. Paul, MN)
- …direct supervision, this position is responsible for: Reviewing/evaluating, approving and processing Medical Only claims with: No lost time beyond statutory ... guidelines, medical position statements, etc.). + Coordinate medical treatment as appropriate: + Review , approve...impacted parties. + Identify the need for and engage nurse resource for utilization review when appropriate.… 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
- Lincoln Financial Group (Columbus, OH)
- …for conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You'll ... to bring on a highly motivated Long-Term Disability (LTD) Claims Specialist to our claims organization. **What...and consulting physicians to make appropriate, ethical, and timely claim determinations. * Reviewing complex medical records… more
- Lincoln Financial Group (Columbus, OH)
- …for conducting initial and ongoing interviews with claimants, obtaining and reviewing medical records, and making timely and ethical claim determinations. You'll ... are excited to bring on a highly motivated **Group Claims Specialist** to support our ever-growing claims ...managers, and consulting physicians to make appropriate and timely claim determinations. + Reviewing complex medical records… more
- Lincoln Financial Group (Columbus, OH)
- …for conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You'll ... professionals through phone and e-mail to gather information regarding Short Term Disability Claims , Family Medical Leaves, and state benefits when applicable. +… more
- Travelers Insurance Company (Buffalo, 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
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …software for financial care activities including eligibility verifications, pre-authorizations, medical necessity, review /updating of patient accounts, etc. * ... *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… more
- The Cigna Group (Bloomfield, CT)
- …Advantage Plan. These appeals will include requests for decisions regarding denials of medical services as well as Part B drugs. The Case Management Analyst will ... to determine the outcome of the appeal; provide oversight and assistance to Medical Management staff with resolution of appeal by interpreting Medicare and Medicaid… 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
- 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
- Travelers Insurance Company (Wyomissing, PA)
- … expertise to defense counsel. + Research medical information to support the claim review process. + Identify medical trends for use in developing ... you do and where you do it. **Job Category** Claim , Nurse - Medical Case...+ Provide objective, concise documentation of medical review in approved report format or in claim… more
- Elevance Health (Waukesha, WI)
- **Clinical Review Nurse I - Medicare Part A**...Nurse I** is responsible for reviewing and making medical determinations as to whether a claim meets ... and reasonableness of the items supplied in a valid claim through the use of medical policy...Hospice experience is a plus. + Prior experience with claim review of Medicare helpful. + CMS… 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
- 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...a week onsite in Augusta.** **Position Duties:** + Manage medical Prior Authorizations (PA) as assigned by the PA… more
- CareFirst (Baltimore, MD)
- …the prevention, reduction of and/or recuperation of losses to CareFirst through the clinical review of medical records and claims , resulting in the savings ... both prepayment reviews and/or post-payment investigations. **ESSENTIAL FUNCTIONS:** + Review of medical records and claims...findings about the ability to pay or deny a claim or claim lines using clinical and/or… more
- Ascension Health (Manhattan, 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
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