- TEKsystems (Chesapeake, VA)
- …Sequence diagnoses and procedures by following the ICD-10-CM Necessary Skills and Strengths: Medical Coding | Nursing Experience | Nurse Auditing | Registered ... As the Nurse Auditor & Hospital Coder If you're ready...between these hours of operation) Workplace Setting - 100% Remote with location restrictions (Must be 2 and a… more
- Adecco US, Inc. (New York, NY)
- …facility staff. + Maintain updated knowledge of the UAS-NY Assessment process. + Review consumer medical documentation and/or health referral forms, as relevant ... homecare experience? Adecco has an amazing opportunity for a ** Remote RN based in Brooklyn, NY. You must have...In-Home (3) Days** **Job Summary:** In this role, the nurse will have the opportunity to conduct home assessments… more
- Sedgwick Government Solutions (Orlando, FL)
- …Nurse Case Manager ( Remote - Strong Internal) 2025-1387 Orlando, FL, USA Medical Case Management Full Time Description Nurse Case Manager (Home Based) - ... + 3 years related clinical experience in discharge planning, oncology, utilization review /management to determine the necessity of medical services, behavioral… more
- CareFirst (Baltimore, MD)
- …mental health, psychiatric setting. **Preferred Qualifications:** + 2 years' experience in Medical Review , Utilization Management or Case Management at CareFirst ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of...and mandates. + Organizes the appeal case for physician review by compiling clinical, contractual, medical policy… more
- 315 health (Warner Robins, GA)
- …confidence in navigating their healthcare. We are looking for a qualified Registered Nurse (RN) to serve our patient population in the navigation, prevention and ... management of their health through continuous care programs like Remote Patient Monitoring and Chronic Care Management. Our team works fervently to anticipate the… more
- CVS Health (Columbus, OH)
- …to make health care more personal, convenient and affordable. **This is a full-time remote position with less than 5% required travel. Requirement to reside in the ... **Position Summary** RN and certified coder Responsible for the review and evaluation of clinical information and documentation related...required + 2+ years of experience as a Registered Nurse + Must have active, current and unrestricted RN… more
- St. Luke's University Health Network (Allentown, PA)
- …Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks outcomes regarding appeal process. Assists billing staff ... outpatient denials for experimental, coding or other issues that may require record review . Provides billing with information needed to obtain payment of claims. … more
- AmeriHealth Caritas (Florence, SC)
- ** Remote to qualified candidates living in South Carolina with a preference of York, Florence, Williamsburg,; Darlington and Horry counties.** Your career starts ... plan of care, referrals, and evaluation of the effectiveness of the plan.; 2. Review medication list and educate Members with pharmacy needs, and counsel on side… more
- VNS Health (Manhattan, NY)
- …components related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical providers, ... Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies… more
- McLaren Health Care (Indianapolis, IN)
- …for utilization management functions. This includes but is not limited to review and authorization of services, utilization of medical policy, utilization ... of high risk, and under and overuse of services. Collaborates with Medical Director and senior management on complex cases and special projects. **This… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …provider communication. + Ensures accurate, timely documentation in the EMR (Electronic Medical Record) according to best practice, guidelines, or workflows _._ + ... in process improvement, professional development, peer development and peer review Licensing/Certification RN license required in applicable state(s). Multistate/Compact… more
- Bon Secours Mercy Health (OH)
- …applicable. Participates in process improvement, professional development, peer development, peer review and shared governance. This document is not an exhaustive ... of our opportunities reward* your hard work with: Comprehensive, affordable medical , dental and vision plans Prescription drug coverage Flexible spending accounts… more
- 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 Metro, CO Job Type Full Time Job Number IKA 02221… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The LPN, under the direction of a registered nurse , licensed physician, or other specified health care professional, participates in patient ... in person responsibilities but also has the ability to work from home. Remote option available after initial training period.** + Additional Shift Details: **Reviews… more
- Veterans Affairs, Veterans Health Administration (Baltimore, MD)
- …This announcement may close without prior notification. The Inpatient Medical -Surgical/Telemetry Unit Registered Nurse (RN) demonstrates leadership and ... the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible...mastery of practice in delivering/providing medical surgical/telemetry nursing care to wide assortment with … more
- Magellan Health Services (Boise, ID)
- …influence quality of care. General Job Information Title Care Manager (SUD utilization review preferred) - REMOTE USA Grade 24 Work Experience - Required ... This role is 100% remote , preference to candidates that live in Idaho....in Idaho. Also interested in candidates with SUD utilization review experience. Under general supervision, and in collaboration with… more
- Community Health Systems (Franklin, TN)
- …admission as an inpatient or to place in outpatient with observation services. + Review medical records for appropriate indicators of the medical necessity ... efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for admission to the… more
- Veterans Affairs, Veterans Health Administration (Portland, OR)
- …within city limits and in the nearby Columbia River Gorge. The Nurse (Outpatient Medical Unit) executes position responsibilities that demonstrate leadership, ... determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.… more
- Veterans Affairs, Veterans Health Administration (Manchester, NH)
- …the EDRP application. Former EDRP participants ineligible to apply. Responsibilities This Registered Nurse position is located in the Medical Specialty Clinic at ... State or territory VA offers a comprehensive total rewards package: VA Nurse Total Rewards Requirements Conditions of Employment US Citizenship; non-citizens may… more
- Medical Mutual of Ohio (OH)
- …of service provided, length of stay and level of care + Extrapolates and summarizes medical information for physician review or other external review + ... Ohio State Nursing Board. Bachelor's degree preferred + 3 years' experience as a Registered Nurse in acute care, critical care, emergency medical or medical … more
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