• Lowes Care Nurse - Case Manager…

    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 ... for medically managing a minimum caseload of 65 including review of claims identified for Medicare Set-Aside....Clinical experience + 3-5 Years of Experience required with Nurse Case Management Software, along with Microsoft Office +… more
    Lowe's (10/30/24)
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  • Medical Director - Medicare

    Molina Healthcare (Phoenix, AZ)
    …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more
    Molina Healthcare (11/02/24)
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  • Utilization Review Nurse Supervisor…

    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 ... administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the largest… more
    The County of Los Angeles (09/30/24)
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  • Utilization Review Nurse (40 Hour)

    State of Connecticut, Department of Administrative Services (Middletown, CT)
    Utilization Review Nurse (40 Hour) Office/On-site Recruitment # 241023-5612FP-001 Location Middletown, CT Date Opened 11/5/2024 12:00:00 AM Salary $78,480 - ... (DCF (https://portal.ct.gov/dcf) ), seeks qualified individuals for a Utilization Review Nurse (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5612FP&R1=&R3=) position. Are you passionate… more
    State of Connecticut, Department of Administrative Services (11/05/24)
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  • Utilization Review Nurse

    Martin's Point Health Care (Portland, ME)
    …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ensuring the ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well as… more
    Martin's Point Health Care (09/24/24)
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  • Utilization Review Nurse

    US Tech Solutions (Chicago, IL)
    …experience with Utilization Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions is a global staff ... clinical policy, regulatory and accreditation guidelines. + Responsible for the review and evaluation of clinical information and documentation. + Reviews… more
    US Tech Solutions (10/18/24)
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  • CDI Specialist (OASIS Review Nurse

    Virtua Health (Marlton, NJ)
    …over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques ... core of our nursing culture. Virtua Home Care is a large, Medicare -certified home health agency that provides multidisciplinary skilled services in Burlington,… more
    Virtua Health (08/16/24)
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  • Utilization Review Nurse

    US Tech Solutions (May, OK)
    …clinical policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. . Reviews ... Care cases across all lines of business (Commercial and Medicare ). . Independently coordinates the clinical resolution with internal/external.... 1+ years of inpatient hospital experience . Registered Nurse in state of residence . Must have prior… more
    US Tech Solutions (10/18/24)
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  • Utilization Management & Quality Review

    UCLA Health (Los Angeles, CA)
    Description As the Utilization Management & Quality Review Nurse , you will be responsible for: + Ensuring appropriate, cost-effective, and high-quality care for ... * Two or more years of experience in utilization management, preferably in Medicare Advantage or managed care * Knowledge of Medicare Advantage regulatory… more
    UCLA Health (10/31/24)
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  • Registered Nurse Clinical Review

    CommonSpirit Health Mountain Region (Durango, CO)
    …leaders who care about your success. Assist with training and coordinating clinical review and quality assurance. Lead and review the appropriateness of clinical ... care and documentation practices related to patients/residents. Review and evaluate quality data to determine areas needing...of the home health and/or hospice patient. + Registered Nurse + Valid CO Driver's License. + BLS Sedentary… more
    CommonSpirit Health Mountain Region (10/03/24)
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  • Clinical Review Nurse - Concurrent…

    Centene Corporation (Austin, TX)
    …competitive benefits including a fresh perspective on workplace flexibility. **Registered Nurse Strongly Preferred** **Must reside and be licensed in the state ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… more
    Centene Corporation (11/02/24)
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  • Clinical Review Nurse - Prior…

    Actalent (Dallas, TX)
    Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse is responsible for analyzing all prior authorization requests to determine the ... healthcare providers and the authorization team to ensure timely review of services and/or requests. + Assess the medical...years of related experience. + LPN - Licensed Practical Nurse - State Licensure required. + Clinical knowledge and… more
    Actalent (10/31/24)
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  • Remote Utilization Review Nurse

    Actalent (Omaha, NE)
    …in medical review or utilization management. + Knowledge of utilization review , Medicare , utilization management, and EMR systems. Additional Skills & ... NurseJob Description We are seeking a dedicated and detail-oriented Utilization Management Nurse to join our team. The ideal candidate will be responsible for… more
    Actalent (10/30/24)
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  • Nurse Auditor - Medical Bill Review

    Rising Medical Solutions (Chicago, IL)
    …was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark in the world of medical cost containment. ... team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance,… more
    Rising Medical Solutions (09/07/24)
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  • HEDIS Review Nurse

    Actalent (Chicago, IL)
    Job Title: HEDIS Review SpecialistJob Description - Will be calling out to providers and doctors' offices to retrieve medical information and ask any follow-up ... Will be part of the Quality Department for the Medicare Team, working alongside full-time members with audits and...part of the HEDIS team during the Jan-May season. Review medical records from all 5 states. Abstracting 6… more
    Actalent (10/27/24)
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  • Licensed Practical Nurse (NY Helps)

    New York State Civil Service (Greenburgh, NY)
    …Agency People With Developmental Disabilities, Office for Title Licensed Practical Nurse (NY HELPS) Occupational Category Health Care, Human/Social Services Salary ... license and current registration to practice as a practical nurse in New York State, OR B: A limited...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more
    New York State Civil Service (09/26/24)
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  • Nurse Practitioner - Hospice

    CareOregon (Portland, OR)
    …care costs and increase provider/care team satisfaction. Housecall Providers has saved Medicare millions of dollars, while providing better care to our patients, ... diseases. This trend will continue as roughly 10,000 baby boomers a day enter the Medicare system. If you receive an offer of employment for this position, it is… more
    CareOregon (10/11/24)
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  • RN Clinical Review Nurse

    Centene Corporation (Sacramento, CA)
    …treatment needs and appropriate level of care preferred. + Knowledge of Medicare and Medicaid regulations preferred. + Knowledge of utilization management processes ... preferred. **License/Certification:** **For Health Net of California: RN license required** Pay Range: $25.97 - $46.68 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition… more
    Centene Corporation (10/31/24)
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  • Customer Solution Center Appeals and Grievances…

    LA Care Health Plan (Los Angeles, CA)
    …for Centers for Medicare and Medicaid Services (CMS), DMHC, and external review organization (QIO or IRE). Process the case thru to effectuation and final case ... Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department:...in a manner consistent with LA Care, Centers of Medicare and Medicaid Services (CMS) and regulatory guidelines. Benefit… more
    LA Care Health Plan (10/11/24)
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  • Registered Nurse Clinical Appeal & Claim

    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 limited ... care + Extrapolates and summarizes medical information for physician review or other external review + Generates...degree preferred + 3 years' experience as a Registered Nurse in acute care, critical care, emergency medical or… more
    Medical Mutual of Ohio (11/01/24)
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