- 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 ... Benefits + Questions WHO WE ARE We will NOT review resumes or cover letters for this position, so...our organization and the Twin Cities region: TheWorkers' Compensation Claims Representativewill administer Minnesota lost time and medical… more
- 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 ... Claims Auditing, Medical Necessity Review and Coding experience + Familiar with state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:**… 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
- Lincoln Financial Group (Columbus, OH)
- …professionals through phone and e-mail to gather information regarding Short Term Disability Claims , Family Medical Leaves, and state benefits when applicable. + ... a Glance** We are excited to bring on a highly motivated Integrated Absence Claims Specialist to staff our ever-growing claims organization. As an Integrated… more
- Lincoln Financial Group (Columbus, OH)
- …a Glance** We are excited to bring on a highly motivated Long-Term Disability (LTD) Claims Specialist to our claims organization. **What you'll be doing** As an ... LTD Claims Specialist, you will manage a workload of Long-Term...initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations.… more
- Lincoln Financial Group (Columbus, OH)
- …Role at a Glance** We are excited to bring on a highly motivated **Group Claims Specialist** to support our ever-growing claims organization in a work from home ... west coast employer groups. _Background details_ As a Group Claims Specialist, you will support our Short Term Disability...requests relating to Short Term Disability, the Family and Medical Leave Act (FMLA), the Americans with Disabilities Act… 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
- 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
- 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
- Travelers Insurance Company (Buffalo, NY)
- …Imagine loving what you do and where you do it. **Job Category** Claim, Nurse - Medical Case Manager **Compensation Overview** The annual base salary range ... Is the Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for prospective,… 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
- 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
- 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
- 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
- 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
- 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 ... team to support both prepayment reviews and/or post-payment investigations. **ESSENTIAL FUNCTIONS:** + Review of medical records and claims . + Investigate… 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
- Elevance Health (Indianapolis, IN)
- ** Nurse Medical Management I** 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 I** is responsible for...care clinical experience. **Preferred Skills, Capabilities, and Experiences:** + Medical management or medical review … more
- State of Massachusetts (Boston, MA)
- …with healthcare providers, including assistance with hospital discharge planning. . Review medical documentation related to payment of foster parents ... staff and to DCF foster/adoptive parents and guardians. The nurse will also assess the medical needs...to MassHealth eligibility, third party insurance, prior approval, and claims . . Work with the Medical Director… more
- GEHA (Lee's Summit, MO)
- …with HEDIS measures and associated gap closure. + Preferred experience with Medical Record Review . + Preferred experience with telephonic member outreach. ... pronounced GEHA) is a nonprofit member association that provides medical and dental benefits to more than two million...experience, sustained by a nimble and efficient organization. The Nurse Consultant II provides professional nursing care to our… more
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