- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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 (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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
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