- Medical Mutual of Ohio (OH)
- … Medicare Supplement, and individual plans. Under limited supervision, the Medicare Nurse Reviewer applies medical necessity guidelines in making ... for applicants that have a strong clinical utilization management background. Medicare experience is a plus. **Responsibilities** + Evaluates clinical information… more
- Parkview North Hospital (Fort Wayne, IN)
- …eligible for a $5,000 sign-on bonus Summary Works independently to perform Medicare Annual Wellness Visits and facilitates advance care planning conversations using ... the evidenced based Respecting Choices model. Accountable for assuring delivery of quality nursing care for the designated patients of PPG in accordance with the… more
- CommuniCare Health Services Corporate (Indianapolis, IN)
- Medicare Biller The CommuniCare Family of Companies currently owns/manages over 130 World-Class Nursing and Rehabilitation Centers, Specialty Care Centers, and ... of adult living communities. CommuniCare Health Services is currently recruiting a Medicare Biller for our Central Billing Office in Cincinnati, OH. PURPOSE/BELIEF… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Working under general ... RN experience, DRG,_** **_and/or_** **_hospital bill auditing experience._** **Responsibilities** ** Medicare Clinical Auditor** + **Audits outpatient, inpatient and professional… more
- AmeriHealth Caritas (Newtown Square, PA)
- **Corporate Director, Population Health Clinical Operations, Medicare ** Location: Newtown Square, PA Primary Job Function: Medical Management ID**: 37990 **Job ... advanced licensure. 5+ years of exp in case and utilization management Medicare program design and implementation. Your career starts now. We're looking for… more
- Elderwood (Buffalo, NY)
- …Elderwood has grown to become the largest network of rehabilitation, skilled nursing , assisted living and independent living communities in Western New York, with ... to providing exceptional care to our residents. Medical Billing Specialist ( Medicare /Managed Care) Position Overview: + Responsible for Managed Care and Insurance… more
- Marshfield Clinic (Beaver Dam, WI)
- …together to support the most exciting missions in the world!** **Job Title:** Nurse Practitioner - Nursing Home **Cost Center:** 351011295 Beaver Dam-NH-Hillside ... Mon-Fri; 8:00 am - 5:00 pm (United States of America) **Job Description:** The Nurse Practitioner- Nursing Home Service functions as a member of our primary… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Under general ... external guidelines.** **Prepares and assigns cases/files to clinical staff ( Nurse , Social Worker, Care Navigator, Physician)** **.** **Responsibilities** + **Sends… more
- Molina Healthcare (Long Beach, CA)
- …medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred ... Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review, and manages the denial… more
- UNC Health Care (Eden, NC)
- …health and well-being of the unique communities we serve. _UNC Rockingham Rehabilitation and Nursing Care Center is a highly ranked nursing center, earning top ... ratings from the Centers for Medicare and Medicaid Services (CMS). The 121-bed facility is...is a favorite spring occurrence._ Summary: Provides competent clinical nursing care consistent with professional standards. Reporting and accountable… more
- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment, you will be an expert in risk adjustment coding and ... required + A Certified Risk Adjustment Coder (CRC), required + Registered Nurse (RN) or clinical qualifications a plus + Bachelor's degree (healthcare or… more
- Molina Healthcare (Spartanburg, SC)
- **JOB DESCRIPTION** Case Manager RN will support our Medicare Population in the state of South Carolina. Case Manager will be required to communicate telephonically ... **JOB QUALIFICATIONS** **Required Education** Graduate from an Accredited School of Nursing . Bachelor's Degree in Nursing preferred. **Required Experience** 1-3… more
- UCLA Health (Los Angeles, CA)
- …can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management, you'll provide direct management to a team of UM coordinators ... and nurses. You'll work closely with Medicare Advantage leadership to plan, execute, and manage various...RN licensure in CA required + Bachelors of Science, Nursing (BSN) degree required + Five or more years… more
- The Cigna Group (Bloomfield, CT)
- This position, the Nurse Case Manager Senior Analyst, through the case management process, will promote the improvement of health outcomes to members and assist ... situations, clients and customers. **Minimum requirements:** + Active and unrestricted Registered Nurse (RN) license in state or territory of the United States +… more
- BrightSpring Health Services (Martinsburg, WV)
- …team of passionate and caring clinicians who make a difference in people's lives. Our nursing group focuses on compassion and meeting the needs of our clients in a ... with Company policies and procedures, state licensure and regulations, Medicaid and Medicare standards, as well as state reimbursement regulations + Leading case… more
- BrightSpring Health Services (Arlington, TX)
- …services provider of choice for senior living communities, skilled nursing facilities, public health organizations and post-acute care organizations. PharMerica ... is one of the nation's largest pharmacy companies. PharMerica offers unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement and the highest hiring goals in decades. For more information about PharMerica,… more
- Fairview Health Services (Edina, MN)
- …Medicaid benefits and senior care industry **License/Certification/Registration** Minnesota Board of Nursing Public Health Nurse license Certification in case ... in a variety of care settings throughout the 11-county metro area. The FVP Nurse (RN) Care Coordinator provides coordination across all settings of care and performs… more
- Aveanna (Atlantic, IA)
- …and documenting skilled nursing care, under the supervision of a Registered Nurse , in accordance with the developed care plan and physicians orders for each ... Private Duty Nurse (LPN) ApplyRefer a FriendBack Job Details Requisition...Details Requisition #: 194191 Location: Atlantic, IA 50022 Category: Nursing Salary: Starting at $25.00 per hour Position Details… more
- New York State Civil Service (Brooklyn, NY)
- NY HELP Yes Agency Mental Health, Office of Title Registered Nurse Supervisor 1 Psychiatric, (NY HELPS), Kingsboro Psychiatric Center, P25877 Occupational Category ... 11203 Minimum Qualifications Kingsboro Psychiatric Center is recruiting a Registered Nurse Supervisor 1 Psychiatric to supervise registered nurses and direct care.… more
- Fairview Health Services (Maplewood, MN)
- …benefits and senior care industry + **License/Certification/Registration** + Minnesota Board of Nursing Public Health Nurse license + Certification in case ... in a variety of care settings throughout the 11-county metro area. The FVP Nurse (RN) Care Coordinator provides coordination across all settings of care and performs… more