- The County of Los Angeles (Los Angeles, CA)
- …REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse * or Medical Service Coordinator, CCS.** -OR- OPTION ... UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333)...needed, and to make recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review… more
- Travelers Insurance Company (St. Paul, MN)
- …case resolution. + Review , approve and issue accurate and timely indemnity, medical and expense payments for lifetime/long-term claims . + Determine Value of ... 2 **What Is the Opportunity?** Under moderate supervision, manage Workers' Compensation Claims with: Stable Lifetime Indemnity and/or Medical Benefits where the… 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
- Baylor Scott & White Health (Dallas, TX)
- …wages for payroll and for all approvals of medical bills per claim file.Pay and process claims within designated authority levelPerforms other position ... of the Safe Choice Claims Manager the Claims Adjuster is responsible for the review ,...reserve requirements, identify subrogation potential, maintain diaryReview and evaluate medical and loss wages, conduct thorough investigation of the… more
- Insight Global (Brookfield, WI)
- …the product across claims operations. * Provide expert guidance on medical management, litigation management, and complex claim handling strategies. * ... implementation for our clients. We are seeking a seasoned claims professional to serve as the claim 's...knowledge of medical cost containment strategies (bill review , utilization review , provider networks, nurse… 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. * ... We are currently seeking a*RCM Representative Senior*to join our Third-Party Claims -HB&PB team. This full-time role will primarily work remotely (Days, M-… 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 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
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry ... and concurrent medical record review for medical ...claim issues or concern that may require clinical review during the pre-bill, audit, or appeal process. +… more
- 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 ... + A conditional offer of employment will require a medical examination. + This position falls under the provisions...Work Behavior as a charge nurse , head nurse , utilization review nurse , quality… 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 is responsible for...for medical necessity reviews. + Manage the review of medical claims disputes,… more
- Commonwealth of Pennsylvania (PA)
- Health Care Nurse Surveyor - Lionville Field Office Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5166325) Apply Health Care Nurse ... person to join our team as a Health Care Nurse Surveyor to evaluate the compliance of nursing homes...will write reports on survey and investigation findings and review plans of correction for necessary components to plan… more
- Blue KC (Workman, MN)
- …pre-transplant, transplant, and post-transplant claims . Sets up transplant pre-pay review for each individual claim . Reviews transplant billing packets and ... authorization letters, and follows in FACETS UM system in accord with UM concurrent review guidelines. Consults with Medical Director on cases outside medical… more
- LA Care Health Plan (Los Angeles, CA)
- … and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. ... Nurse Coder RN III Job Category: Clinical Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position...team lead on any issues identified during research or claims review . Applies subject expertise in evaluating… more
- CDPHP (Latham, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care initial… more
- Centene Corporation (New York, NY)
- …license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for ... and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review and… more
- Ventura County (Ventura, CA)
- …patient-centered care. Under general direction, the Senior Medical Management Nurse is responsible for performing utilization review , case management, and ... Senior Medical Management Nurse - VCHCP Print...are not limited to the following: + Performs utilization review with pre-certification, concurrent, retrospective, out of network and… more
- Ascension Health (Tulsa, OK)
- … claims , qualityindicators and other risk-related data. + Coordinate the medical staff's professional performance evaluation and peer review programs in ... and corrective action where appropriate. + Collaborate in any investigative, judicial review or appeal process involving medical or allied health staff… more
- Chenega Corporation (Rockville, MD)
- …compensation programs, or managed care. + Professional Background: Relevant experience in claims review , healthcare administration, or related fields. + A ... program knowledge, leadership, and/or support experience. + Must have experience in claims review , healthcare administration, or related fields. + Must have… more
- Beth Israel Lahey Health (Burlington, MA)
- …not just taking a job, you're making a difference in people's lives.** RN - Employee Health Nurse - Lahey Medical Center - Burlington, MA. 32 hrs. Days M-F. RN - ... Employee Health Nurse - Lahey Medical Center - Burlington,...**Job Description:** 1. Conducts initial post-offer/pre-placement physical assessment, including review of immunization status, and provides required testing or… more