- 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
- Robert Half Accountemps (New Haven, CT)
- …throughout the process. Responsibilities: * Handle all aspects of workers compensation lost time claims from set-up to case closure * Review claim and policy ... Description We are seeking an experienced Claims Examiner-Lost Time to join our team in...and taking statements as necessary with insured claimant and medical providers * Evaluate the facts gathered through the… 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
- 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
- Actalent (Omaha, NE)
- … claims and preauthorization processing. This role involves accurate and timely medical review of claims , preauthorizations, and customer service ... and preauthorization processing. + Perform accurate and timely medical reviews of claims and preauthorizations. +...medical policy. + Verify member eligibility prior to medical review . + Foster constructive relationships with… 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 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
- 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
- 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
- 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
- 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 medically managing a minimum caseload of 65 including review of claims identified for Medicare Set-Aside.… more
- 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
- 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
- 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
- Elevance Health (Middletown, NY)
- ** Nurse Medical Management I** **LOCATION** **: This is a remote position working from home; however, you** **must** **be within 50 miles of one of the offices ... NY **HOURS: Monday - Friday, 8:30am - 5:00pm.** The ** Nurse Medical Management I** is responsible to... directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied.… more
- Elevance Health (Tampa, FL)
- Job Description ** Nurse Medical Management Sr.** **Preferred Location** : Florida. **This position will work 100% remote (with the exception of team meetings ... miles of one of our Elevance Health PulsePoint locations. ** Nurse Medical Management Sr.** Responsible to serves... directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied.… more
- Elevance Health (Wallingford, CT)
- ** Nurse Medical Management Sr** **Location:** South Portland, ME; Wallingford, CT & Manchester, NH. This position will work a hybrid model (remote and office). ... of the Elevance Health PulsePoint locations listed above. The ** Nurse Medical Management Sr** will be responsible... directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied.… more
- Elevance Health (Tampa, FL)
- ** Nurse Medical Management I** **Preferred Location** : Florida. **This position will work 100% remote (with the exception of team meetings which will be held on ... miles of one of our Elevance Health PulsePoint locations. ** Nurse Medical Management I** Responsible to collaborate... directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied.… more
- Elevance Health (Tampa, FL)
- ** Nurse Medical Management I** **Location:** This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of on of ... our Elevance Health PulsePoint locations. The ** Nurse Medical Management I** will be responsible... directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied.… more
- Elevance Health (Hialeah, FL)
- ** Nurse Medical Management I** **location: multiple states: Texas, Florida an Maryland** or The ideal candidate will live within 50 miles of one of our ... **Hours: Monday - Friday, Includes weekends and Holidays.** The ** Nurse Medical Management I** is responsible to... directors in interpreting appropriateness of care and accurate claims payment. + May also manage appeals for services… more
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