- 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
- U-Haul (Phoenix, AZ)
- …Repwest, you will be responsible for investigating, evaluating, and resolving property damage claims . Essential Duties: + Review claims to determine coverage ... United States of America Repwest Insurance is seeking a Claims Adjuster to handle Truck, Trailer and Storage property...Registered Dietitian Program + Weight Watchers + Onsite medical clinic for you and your family + Career… 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 ... reflection of our clients and the people they serve. ** Registered Nurse - Authorization Review Unit -...a week onsite in Augusta.** **Position Duties:** + Manage medical Prior Authorizations (PA) as assigned by the PA… 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
- Intermountain Health (Murray, UT)
- …etc.) + Reviews outpatient pre-authorization requests and/or retrospective requests through claims review and incoming requests through fax, electronic ... Proactively manage inpatient and outpatient utilization to assure that medical care is appropriate, efficient, and medically necessary. Support facility… more
- Veterans Affairs, Veterans Health Administration (Chicago, IL)
- …of recommendations; Management Review and Improvement; performance measures; Tort Claims which entails management of medical records and peer reviews ... Summary The Jesse Brown VA Medical Center Registered Nurse (RN) -...the Chief of Staff in the investigation of Tort Claims that entail management of medical records… 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 Manager **Compensation...Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity… more
- The County of Los Angeles (Los Angeles, CA)
- REGISTERED NURSE I, SHERIFF (CORRECTIONAL HEALTH) Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2930992) Apply REGISTERED NURSE I, ... of Los Angeles is currently offering up to 20% bonus for full-time Registered Nurse I, Sheriff positions hired by Correctional Health Services and working on-site… more
- Montana State University-Northern (Havre, MT)
- Clinical Resource Registered Nurse (CRRN) part-time Below you will find the details for the position including any supplementary documentation and questions you ... should review before applying for the opening. To apply for...Details Position Information NBAPOSN Title Working Title Clinical Resource Registered Nurse (CRRN) part-time Brief Position Overview The Clinical… more
- The County of Los Angeles (Los Angeles, CA)
- SUPERVISING REGISTERED VETERINARY TECHNICIAN Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4531245) Apply SUPERVISING REGISTERED ... to closure without notice. Under general supervision, supervise a team of Registered Veterinary Technician and/or ancillary staff positions in the County of Los… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …member and provider call center, provider correspondence and appeals, clinical review , member correspondence and reconsiderations, enrollment, claims processing, ... account Position Summary: The RN Clinical Provider Post Service Review Manager , led by a Registered ...partnership with key business partners, such as the physician review unit, health and medical management, network… more
- Montana Tech (Butte, MT)
- Clinical Resource Registered Nurse/ Instructor or Assistant Professor Montana Technological University provides a comprehensive benefits package for all eligible ... program. Applications received by September 30, 2024 will be guaranteed full review and consideration. Applications received after that date may be considered until… more
- State of Massachusetts (Boston, MA)
- …with healthcare providers, including assistance with hospital discharge planning. . Review medical documentation related to payment of foster parents ... to MassHealth eligibility, third party insurance, prior approval, and claims . . Work with the Medical Director...registered nurse in a recognized hospital, clinic or medical facility and (B) of which at least two… more
- SSM Health (Waupun, WI)
- …for Waupun and Ripon locations, completing vitals, medication management, insurance claims and nursing assessments when needed.** **Benefits** Medical , Dental, ... and Requirements:** PRIMARY RESPONSIBILITIES + Reviews all patients identified for review to determine the medical necessity and appropriateness of… more
- The County of Los Angeles (Los Angeles, CA)
- REGISTERED VETERINARY TECHNICIAN Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/3088151) Apply REGISTERED VETERINARY TECHNICIAN Salary ... for independently providing paramedical treatment to animals, providing more complex medical treatment under the direction of a licensed veterinarian, and assisting… more
- St. Mary's Healthcare (Amsterdam, NY)
- …utilization review departments in attempts of obtaining authorizations and claim payment. * Establishes and maintains positive and cooperative relationships with ... and resolve billing inconsistencies. * Reviews commercial and government claim denials and audit requests and coordinates attempts to... medical staff and care coordination leaders to ensure ongoing… more
- Trinity Health (Syracuse, NY)
- …liaison between emergency services, surgical services, nursing, finance, physicians, utilization review , and medical records. In addition, they are responsible ... network referrals. The scope of this position includes all medical treatment and levels of care. The Care Compass...claims payment knowledge to pre and post service review . + Analyzes utilization management trends. + Unit and… more
- MyFlorida (Tallahassee, FL)
- …Needy cases), reviewing claims that are initialized through the automated claims process, initial review , pre-development, and assignment of disability ... Electronic Worksheet (EWS) when appropriate. Conducts the initial file review upon receipt of claim . Reviews disability... upon receipt of claim . Reviews disability claim to determine completeness of file. Reviews medical… more
- Sojourner House (Pittsburgh, PA)
- …PA licensure with 2+ years' related mental health experience. Previous experience with medical claim forms. + Ability to obtain mental health certification ... Sojourner House is seeking an experienced Psychiatric Registered Nurse Practitioner to provide psychiatric services within our licensed inpatient substance use… more
- Sutter Health (San Francisco, CA)
- …quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and ... patient experience. The RN Case Manager works in collaboration with the Physician, Medical Social Worker and bedside RN to assure the timely movement of patients… more