- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II is primarily responsible for the overall coordination of the Appeals… more
- Veterans Affairs, Veterans Health Administration (Eureka, CA)
- …the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities Duties and responsibilities Incumbent ... performs retrospective medical review of non-VA health care records to determine medical...involving others in improving care. Identifies and assesses resource utilization and safety issues, taking appropriate action. Acquires knowledge… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- POSITION TITLE: Utilization Review Clinician REPORTS TO (TITLE): Director of Utilization Review DESCRIPTION OF POSITION: Work as member of ... party payers. + Recordkeeping: Maintains appropriate records of the Utilization Review Department. + Training: Provide staff...license as an LCSW, ASW, MFT, LMFT, RN, LPT, LVN or LPC + Preferred; Master's degree in Social… more
- Kelsey-Seybold Clinic (Pearland, TX)
- **Responsibilities** The Utilization Review LVN nurse will perform documentation review for medical necessity and benefit correlation of requested ... admissions for HMO, PPO and POS products. The UR LVN nurse will serve as facilitator of communication with...Licensed Vocational Nurse Utilization Review -** ** Utilization Management-Sign on Bonus $2,500** **Location: Remote **… more
- Elevance Health (Norfolk, VA)
- **Title:** Licensed Utilization Review II **Location** : This position will work a remote model, but candidates must live within 50 miles of one of our ... 1 weekend day as discussed with manager. The **Licensed Utilization Review II** is responsible for working...Current active unrestricted license or certification as a LPN, LVN , or RN to practice as a health professional… more
- Adecco US, Inc. (Minneapolis, MN)
- Adecco Healthcare & Life Sciences is hiring remote Utilization Management LPNs! This role is in fully remote and equipment will be provided. Please read ... from an accredited Licensed Vocational/Practical Nurse program . Current LVN /LPN license in State of Residence . 2+ years...State of Residence . 2+ years of care management, utilization review (prior authorization) or discharge planning… more
- Molina Healthcare (Spokane, WA)
- …with a WA state LPN licensure. Candidates with p** **revious Utilization Management and Prior Authorization experience are highly preferred** **.** **_Further ... following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse ( LVN ) or Licensed Practical Nurse (LPN) Program OR a bachelor's or master's… more
- Molina Healthcare (New York, NY)
- …performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), ... encouraged to apply.** **_Further details to be discussed during our interview process._** ** Remote position within the tri city areas- New York, New Jersey, or… more
- RWJBarnabas Health (Oceanport, NJ)
- …Status:Full-Time Shift:Day Facility:RWJBarnabas Health Corporate Services Department:Appeals Location: Remote , 2 Crescent Place, Oceanport, NJ 07757 Job Overview: ... is responsible for managing medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. Where… more
- Centene Corporation (New York, NY)
- …applicable criteria, and analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with State, Federal and NCQA ... of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - Licensed Practical… more
- Integra Partners (Troy, MI)
- …do whatever it takes to get things done. PREFERRED SKILLS: + Certification in Utilization Review or Case Management + Experience with health insurance operations ... & Development team as an Operations UM Training Specialist, specializing in Utilization Management (UM) processes. The ideal candidate will have a strong nursing… more
- ManpowerGroup (Columbia, SC)
- …of medical claims review processes, medical necessity guidelines, and utilization review practices. + Proficiency in medical terminology, coding procedures, ... **Job Title: Medical Claims Reviewer** **Pay Rate:23/Hr ( REMOTE opportunity after training)** **Duration:3+ Months on W2**...services. + Ensure thorough documentation of each determination for utilization or claims review . + Review… more
- Centene Corporation (Austin, TX)
- …from their home anywhere in the Central time zone. **Position Purpose:** Conduct review of delegated entities for compliance with quality, service performance and ... utilization , credentialing reviews and medical record audits. Perform community...to quality of care issues. + Audit medical records, review administrative claims and analyze data and interventions for… more