• (RN) Care Review Clinician, Inpatient…

    Molina Healthcare (TX)
    …Certification, Association** Active and unrestricted Licensed Clinical Social Worker Registered Nurse , Compact nursing licensure _WORK HOURS 5 days / daytime work ... schedule, some weekends and holidays. *PREFERRED , Tues thru Saturday or Sunday thru Thursday._ To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a… more
    Molina Healthcare (11/27/24)
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  • Clinical Services Support Specialist…

    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 ... supervision,** **performs administrative functions in support of assigned utilization review or case management department. Receives and reviews correspondence from… more
    Medical Mutual of Ohio (11/16/24)
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  • Medical Director- Medicare (CA)

    Molina Healthcare (Long Beach, CA)
    …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 (11/21/24)
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  • Cigna Medicare Population Health Transplant…

    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 ... for the transplant members assigned to their caseload. This will require review of clinical information and correspondence with facilities to make determinations on… more
    The Cigna Group (11/21/24)
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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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  • Clinical Review Nurse VHS- Woodland…

    Hackensack Meridian Health (Little Falls, NJ)
    …for coding, OASIS and Hospice, and other clinical assessment tools as needed. + Review every Medicare and Managed Medicare admission chart to determine ... in the system if inappropriate codes are identified. + Review each Hospice assessment to assure each CTI, 485...of the certified operation, Hospice Clinical Director, and the Nurse Manager for the appropriate operation. Demonstrates the ability… more
    Hackensack Meridian Health (11/14/24)
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  • Clinical Review Nurse -FT (Ocean…

    Hackensack Meridian Health (Brick, NJ)
    …for coding, OASIS and Hospice, and other clinical assessment tools as needed. + Review every Medicare and Managed Medicare admission chart to determine ... in the system if inappropriate codes are identified. + Review each Hospice assessment to assure each CTI, 485...of the certified operation, Hospice Clinical Director, and the Nurse Manager for the appropriate operation. Demonstrates the ability… more
    Hackensack Meridian Health (11/07/24)
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  • Quality Review Nurse (Remote)

    CareFirst (Baltimore, MD)
    **Resp & Qualifications** **PURPOSE:** The role of the Quality Review Nurse (RN) is to evaluate clinical quality and procedures within the Clinical Appeals & ... Utilization Management, Case Management, Claims, Quality Management and Compliance. The Nurse , Quality Review position develops procedures and reinforce quality… more
    CareFirst (11/15/24)
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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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  • 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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  • 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 (11/13/24)
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  • Clinical Review Nurse - Prior…

    Centene Corporation (Raleigh, NC)
    …criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care + ... care to members + Provides feedback on opportunities to improve the authorization review process for members + Performs other duties as assigned + Complies with… more
    Centene Corporation (11/27/24)
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  • Utilization Review Nurse

    Catholic Health Initiatives (Little Rock, AR)
    **Overview** As a Utilization Review nurse with CHI St Vincent Little Rock, you'll work with physicians, other registered nurses, specialized departments, and ... from records and maintains statistics. + Monitors and tracts Medicare denials, works with medical records to review... Medicare denials, works with medical records to review third party payor denials. + Works with other… more
    Catholic Health Initiatives (11/27/24)
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  • Clinical Review Nurse - Concurrent…

    Centene Corporation (Reno, NV)
    …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers on utilization… more
    Centene Corporation (11/24/24)
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  • NP / 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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  • Registered Nurse Clinical Appeal & Claim

    Medical Mutual of Ohio (OH)
    …are looking for applicants that have a strong clinical utilization management background. Medicare experience is a plus. **Founded in 1934, Medical Mutual is the ... self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.**...care + Extrapolates and summarizes medical information for physician review or other external review + Generates… more
    Medical Mutual of Ohio (11/15/24)
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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 (11/20/24)
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  • Unit Nurse Manager-Adolescent Behavioral…

    State of Colorado (Pueblo, CO)
    Unit Nurse Manager-Adolescent Behavioral Treatment Unit CMHHIP - $25,000 SIGN ON INCENTIVE!! Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4744238) Apply  Unit Nurse Manager-Adolescent Behavioral Treatment Unit CMHHIP - $25,000 SIGN ON… more
    State of Colorado (11/26/24)
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  • RN / Registered Nurse - 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 (11/19/24)
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  • Youth Corrections Medical Operations Coordinator…

    State of Colorado (Denver, CO)
    Youth Corrections Medical Operations Coordinator ( Nurse V) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4573875) Apply  Youth Corrections ... Medical Operations Coordinator ( Nurse V) Salary $108,540.00 - $151,968.00 Annually Location Denver...provides support for performance evaluations. This role also includes review and implementation of preventive health care services, program,… more
    State of Colorado (10/19/24)
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