- Rising Medical Solutions (Chicago, IL)
- …With offices, providers, and case managers nationwide, RISING provides comprehensive medical claims solutions to our valued clients: insurance carriers, ... business was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse ...in acute care, surgery and/or orthopedic + Workers' Compensation medical bill review experience a major plus… more
- Robert Half Accountemps (New Haven, CT)
- …of workers compensation lost time claims from set-up to case closure * Review claim and policy information to provide background for investigation * Conduct ... and indemnity benefits throughout the life of the claim * Review the claim ...initiatives * Comply with customer service requests including Special Claims Handling procedures, file status notes, and claim… more
- Metropolitan Council (St. Paul, MN)
- …+ Participate in bi-annual claims meetings with internal departments. + Review medical , legal, and miscellaneous invoices to determine if reasonable and ... to our organization and the Twin Cities region: TheWorkers' Compensation Claims Representativewill administer Minnesota lost time and medical -only Workers'… more
- Travelers Insurance Company (Buffalo, NY)
- …Network per jurisdictional guidelines. + Research medical information to support the claim review process. + Occasional contact with provider to ensure the ... you do and where you do it. **Job Category** Claim , Nurse - Medical Case...Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …software for financial care activities including eligibility verifications, pre-authorizations, medical necessity, review /updating of patient accounts, etc. * ... *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… 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
- The Arora Group (Bethesda, MD)
- Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in Bethesda, ... required on Federal holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW : + Initiate,...clinical information and may also provide education on the medical review process. + The Contractor performing… more
- Martin's Point Health Care (Portland, ME)
- …performs medical necessity reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate ... Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of...for medical necessity reviews. + Manage the review of medical claims disputes,… more
- State of Connecticut, Department of Administrative Services (Middletown, CT)
- … medical treatment facility, in rehabilitative or occupational nursing or providing medical review of insurance claims . MINIMUM QUALIFICATIONS - ... Utilization Review Nurse (40 Hour) Office/On-site Recruitment...party administrator files to oversee contractor handling; + May review medical records of various health care… more
- US Tech Solutions (Columbia, SC)
- …Utilizes available resources to promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for ... healthcare needs of our members. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying… more
- Commonwealth of Pennsylvania (PA)
- …I have professional experience performing this Work Behavior as a charge nurse , head nurse , utilization review nurse , quality assurance nurse , or an ... reported. Accurate recording of daily care in the electronic medical record system is essential. Additionally, you will manage...Work Behavior as a charge nurse , head nurse , utilization review nurse , quality… more
- Lincoln Financial Group (Columbus, OH)
- …organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you ... will act as a clinical resource for Group Protection benefit specialists and claim professionals. You will evaluate medical information to clarify diagnoses,… 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
- Lowe's (Charlotte, NC)
- …a clinical position. + 3-5 Years of Experience as a Case Manager or Utilization Review Nurse in worker's compensation + Experience in a clinical position + 1-2 ... early intervention, return to work planning, coordination of quality medical care on claims involving disability and...for ensuring that employees receive appropriate treatment and/or assist claim examiners in managing medical treatment to… more
- Catholic Health Initiatives (Corning, IA)
- …professional services. 4. Attend professional conventions, post-graduate seminars, and continuing medical education programs to maintain and enhance Nurse ... procedures, and applicable laws. 9. Participate in Network credentialing and peer review activities. 10. Assist Network and Hospital/ Medical Center in obtaining… more
- NJM Insurance (Trenton, NJ)
- …Auto (PIP/Medpay) lines of business by performing prospective and retrospective Utilization Review of medical services/treatment requested or rendered by ... and/or evidence-based guidelines. Job Responsibilities: + Accurately and effectively evaluate the claim history and current medical records against NJM … more
- Ventura County (Ventura, CA)
- Senior Medical Management Nurse - VCHCP Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4591361) Apply Senior Medical Management ... to County employees and their covered dependents. The Senior Registered Nurse -Ambulatory Care series is distinguished from other nursing classifications in that… more
- Travelers Insurance Company (Tampa, FL)
- …on collaboration. Imagine loving what you do and where you do it. **Job Category** Claim , Nurse - Medical Case Manager **Compensation Overview** The annual ... environment. **What Will You Do?** + Perform a detailed review of previously submitted complex surgical services bills along...Product team. + Deliver superior customer service to Travelers Claim professionals and those medical providers with… more
- State of Georgia (Fulton County, GA)
- …additional experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT codes ... Nurse Investigator Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/51086/other-jobs-matching/location-only)...clinical experience AND one (1) year experience working with medical claims . Preference will be given to… more
- Elevance Health (Tampa, FL)
- Job Description ** Nurse Medical Management Sr.** **Preferred Location** : Florida. **This position will work 100% remote (with the exception of team meetings ... miles of one of our Elevance Health PulsePoint locations. ** Nurse Medical Management Sr.** Responsible to serves... directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied.… more