- Aequor (New York, NY)
- …nursing professional Minimum experience of 1-3 years in case management, utilization review and/or quality assurance Experience in episodic care, wellness care and ... Medical Leave of Absences (Short Term Disability, FMLA, ADA) by tracking claims and communicate case status to employees, mangers, human resources, legal, and… more
- Mindlance (Columbia, SC)
- …Coordinator Job Location: Columbia, SC Top 3/5 Skills: . RN / Registered Nurse License . Chronic condition care . Case Management Job Responsibilities Reviews and ... or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare continuum to… more
- A-Line Staffing Solutions (Haverhill, FL)
- …Management, Certified Case Manager, Medical Coding, BSN, Medical Management, Utilization Review , Utilization Management, Registered Nurse , MCO, RN, HMO, ... Concurrent Review , Retrospective Review , Managed Care, Medical Claims , Appeals, Mail...Review , Retrospective Review , Managed Care, Medical Claims , Appeals, Mail Order Medications, Insurance Verification, Pharmacy, Prior… more
- A-Line Staffing Solutions (Tampa, FL)
- …Management, Certified Case Manager, Medical Coding, BSN, Medical Management, Utilization Review , Utilization Management, Registered Nurse , MCO, RN, HMO, ... Concurrent Review , Retrospective Review , Managed Care, Medical Claims , Appeals, Mail...Review , Retrospective Review , Managed Care, Medical Claims , Appeals, Mail Order Medications, Insurance Verification, Pharmacy, Prior… more
- A-Line Staffing Solutions (Irving, TX)
- …control. Tasks are subject to sequential or final verification by a registered nurse or a registered pharmacist. Supports and adheres to the US Oncology Compliance ... regulation, and only at the direction of the supervising pharmacist after their review of the prescription in accordance with The Company policy and procedure.… more
- New York State Civil Service (Melville, NY)
- …Compensation Board Medical Treatment Guidelines for Claims Service Managers and other Claims staff. Each Registered Nurse 2 will be assigned to one of ... NY HELP Yes Agency Insurance Fund, State Title Registered Nurse 2 - Medical Care (NY HELPS) Occupational Category...public health, community health, visiting nursing, occupational health, utilization review , or review of medical records from… more
- City of New York (New York, NY)
- …The Division of Liens and Recovery Casualty Program places liens and assert claims against the personal injury lawsuit settlements of past or present recipients of ... of Nurses to function as a Complex Medical Case Reviewer , who will: - Conduct medical reviews and analyses..., who will: - Conduct medical reviews and analyses claims to calculate injury related Medicaid liens pursuant to… more
- Martin's Point Health Care (Portland, ME)
- …and performs medical necessity reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate ... Work" since 2015. Position Summary Job Description The Utilization Review Nurse works as a member of...internal guidelines for medical necessity reviews. + Manage the review of medical claims disputes, records, and… more
- Elevance Health (St. Louis, MO)
- **Clinical Review Nurse I - Medicare Part B**...pm EST or CST. Hours are flexible.** The **Clinical Nurse Reviewer I** is responsible for reviewing and ... information is strongly preferred. + Processing Part B clinical claims in MCS. + Experience with dental claims...desired but not required. + Prior experience with claim review of Medicare helpful. + Proficient in basic math… more
- Lincoln Financial Group (Columbus, OH)
- …a Glance** We are excited to bring on a highly motivated Long-Term Disability (LTD) Claims Specialist to our claims organization. As an LTD Claims ... Specialist, you will manage a workload of Long-Term Disability claims independently in accordance with established procedures and guidelines. You will be responsible… more
- Lincoln Financial Group (Columbus, OH)
- …at a Glance** We are excited to bring on highly motivated Short Term Disability Claims Specialists to staff our ever-growing claims organization. As a Short Term ... about a Day in the Life (https://www.youtube.com/watch?v=vbSYiXOPSII&feature=youtu.be) of a Claims Specialist at Lincoln Financial Group! **What you'll be doing**… more
- Lincoln Financial Group (Columbus, OH)
- …Role at a Glance** We are excited to bring on a highly motivated **Group Claims Specialist** to support our ever-growing claims organization in a work from home ... to support our west coast employer groups. _Background details_ As a Group Claims Specialist, you will support our Short Term Disability or Integrated Absence teams.… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …We are currently seeking an *RCM Representative Senior* to join our *Third-Party Claims - HB & PB *team. This full-time role will primarily work remotely (SHIFT: ... service and timely response to questions and issues related to benefits, billing, claims , payments, etc. * Answers questions (by phone and in-person) and provides… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *SUMMARY:* We are currently seeking an*RCM Representative Senior*to join our*Third-Party Claims - HB & PB *team. This full-time role will primarily work remotely ... service and timely response to questions and issues related to benefits, billing, claims , payments, etc. * Answers questions (by phone and in-person) and provides… more
- Martin's Point Health Care (Portland, ME)
- …Utilization Review Nurse works as a member of the Utilization Review Team and is responsible for reviewing claims disputes and retrospective requests for ... clinical review prior to payment. The Utilization Review Nurse will use appropriate governmental policies...medical outcomes. Job Description Key Outcomes/Results: + Manages the review of medical claims disputes, records, and… more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- Utilization Review Nurse (40 Hour) Office/On-Site Recruitment # 240604-5612FP-002 Location Hartford, CT Date Opened 6/5/2024 12:00:00 AM Salary $76,565 - ... is seeking a highly motivated and compassionate U tilization Review Nurse (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5612FP&R1=&R3=) to join our team!… 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 Center, one...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... reviews for acute and subacute rehabilitation, transportation and DME requests. Review of identified high-cost admissions and extended stays and inpatient… more
- Public Consulting Group (Augusta, ME)
- **Overview** **Registered Nurse - Health Services Consultant** **Authorization Review - Office of MaineCare Services in Augusta, ME** This role will be Fulltime ... by the PA supervisor, utilizing PA software tools; + Review and authorize provider requests for the following services...PAs; + Collaborate with other OMS units to resolve claims issues that involve PAs; + Respond to questions… more
- LTCG (MN)
- * Review onsite assessments for consistency and quality and collaborates with the field nurse . * Obtain information from the field assessor to clarify ... company formats, when appropriate. * Manages the clinical quality review for the completed assessments. * Act with independent...the department. * Other duties as assigned. * Registered Nurse : Two years of geriatric experience or * Licensed… more
