- CHRISTUS Health (Mansura, LA)
- …The NP, in conjunction with the Medical Director, participates in the periodic review of the patient's health records under his/her care. The NP arranges for ... Under the supervision of the School Based Health Centers Director, the Nurse Practitioner has the responsibility and accountability for providing primary care to… more
- CHRISTUS Health (Wake Village, TX)
- …and departmental policy to provide expected patient outcome; documents in the medical record and records changes appropriately. Follows policy and procedure ... Description Summary: A Registered Professional Dialysis Nurse is responsible for the delivery of patient care through the process of assessment, diagnosis, planning,… more
- R1 RCM (Chicago, IL)
- …and workflow orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to draft appeals of denied and ... will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid claims. + Apply… more
- Vanderbilt University Medical Center (Nashville, TN)
- …phrases, message basket management, sending communications * Experience/proficiency with medical records nomenclature and processes, including the processing, ... every day or so * Comfortable with the clinical review of testing results and visit plans to determine...extraction, and upload of medical records * Experience/proficiency in the use… more
- Rising Medical Solutions (Chicago, IL)
- …by giving clients the information they need to determine case value based on evaluation of medical records and medical billing statements, and will: + Audit ... business was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse ...medical and billing records to determine if services provided are reasonable, appropriate… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- …for purposes of maximizing reimbursement revenue via Medicare Part B programs; + May review medical records and compile documents for case presentations; + ... Utilization Review Nurse Coordinator (40 Hour) Office/On-site... Review Nurses and other staff engaged in review of medical records of...and other staff engaged in review of medical records of individuals in state health… 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
- State of Connecticut, Department of Administrative Services (Middletown, CT)
- …monitor agency and third party administrator files to oversee contractor handling; + May review medical records of various health care eligibility, resource ... Utilization Review Nurse (40 Hour) Office/On-site Recruitment...treatment facility, in rehabilitative or occupational nursing or providing medical review of insurance claims. MINIMUM QUALIFICATIONS… more
- State of Georgia (Thomas County, GA)
- …health problems and needs, develop and implement nursing care plans, and maintain medical records . . Advise clients on health maintenance and disease prevention ... Registered Nurse (Regional Quality Review (RQR)) -...aimed at assessing the quality of the environment, health, medical supports and community integration of the individual. .… more
- Martin's Point Health Care (Portland, ME)
- …policies, and internal guidelines for medical necessity reviews. + Manage the review of medical claims disputes, records , and authorizations for billing, ... Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of... Review prior authorization requests (prior authorization, concurrent review , and retrospective review ) for medical… more
- Virtua Health (Marlton, NJ)
- …plans to improve outcomes.Position Responsibilities:* Evaluates and analyzes medical records concurrently for proper documentation. This review includes new ... to participate in performance improvement activities. Summary:Evaluates and analyzes medical records concurrently for proper documentation.Collaborates with HIM… 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
- Centene Corporation (Nashville, TN)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... time zone. **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with… more
- Centene Corporation (Sacramento, CA)
- …compliance. + Performs a clinical review of post-care services by reviewing medical records against guidelines and clinical research criteria to determine if ... at the most efficient and effective level + Reviews medical records for medical necessity...of care issues, and if identified, refer to the Medical Director or provider for review and… more
- Ascension Health (Manhattan, KS)
- …cases. + Assist departmental staff with issues related to coding, medical records /documentation, precertification, reimbursement and claim denials/appeals. + ... health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests within assigned… more
- BayCare Health System (Clearwater, FL)
- …facilitate optimal care and treatment and-or to obtain needed medical records for completion of the retrospective review process. **Minimum Qualifications:** ... be working remotely?** Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review Nurse - Health Plan **Location** Clearwater:Park Place… more
- Bassett Healthcare (Cooperstown, NY)
- …discuss specific positions in our conversations. What you'll do The Registered Professional Nurse (RN), Acute Care in the Medical Inpatient units is accountable ... best quality of life possible. About the department Bassett Medical Center's Medical Inpatient units are on...than 2-3 exceptions, as measured by random supervisory chart review and/or direct supervisory observation Implements and records… more
- Actalent (Chicago, IL)
- …audits and provider clean-up. - Will be part of the HEDIS team during the Jan-May season. Review medical records from all 5 states. Abstracting 6 medical ... to have strong clinical knowledge/experience in order to interpret medical records /charts to find the necessary information....care set forth by the insurance company. Experience with medical record review required. Hard Skills +… more
- Trinity Health (Mason City, IA)
- …+ Reviews written test preparation handout with patient and documents in medical record. Refers patient to provider/ nurse if further patient education ... + Reviews written test preparation handout with patient and documents in medical record. + Refers patient to provider/registered nurse if patient… more
- Trinity Health (Mason City, IA)
- …tests/referrals. Reviews written test preparation handout with patient and documents in medical record. Refers patient to provider/registered nurse if patient ... the physician or ACP. The physician or ACP will review and approve actions to taken at key junctures...necessary **Minimum Qualifications:** Education: Successful completion of a formal Nurse Aid or Emergency Medical Technician course/training… more
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