- 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
- 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
- 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
- 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
- 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 provided ... Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for prospective, concurrent,… more
- US Tech Solutions (Houston, TX)
- …implements, and maintains educational tools to help providers reduce the submission of claims for non-covered services and reduce the claims payment error rate. ... compliance. + Provides clinical input for internal requests. Serves as reviewer to determine inter-rater reliability. **Experience:** + 7 years-clinical experience… more
- Pilgrim's (Moorefield, WV)
- …Position Description MOOREFIELD PREPARED FOODS Position Title: Occupational Health Nurse Evening Shift Employee: Reports to: Occupational Health Manager Department: ... Salaried Non Exempt Pay Grade: Salaried Non Exempt Author: Reviewer : Position Summary: In two - four sentences, what...area medical community in dealing with WV Workers Compensation claims Report s all Lost Time and Recordable injuries… more
- Elevance Health (Columbus, OH)
- …of utilization and/or fraudulent activities by health care providers through prepayment claims review , post payment auditing, and provider record review ... ** Nurse Audit Lead** **Supports the Carelon Payment Integrity...make an impact:** + Develops, maintains and enhances the claims review process. + Assists management with… more
- State of Georgia (Fulton County, GA)
- …Specific, additional experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT ... Nurse Investigator Georgia - Fulton - Atlanta (https://careers.georgia.gov/jobs/51086/other-jobs-matching/location-only) Hot… more
- Vighter Medical Group (San Antonio, TX)
- QTC Nurse Practitioner PT Job Details Job Location San Antonio TX - San Antonio, TX Position Type Part Time Education Level Master's Degree Travel Percentage None ... Job Shift Day Job Category Health Care Description Position Description: Nurse Practitioner to perform compensation and pension examinations as a Vighter LLC employee… more
- US Tech Solutions (Columbia, SC)
- …provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate, ... effective outcomes. Responsibilities: . *50% Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit… more
- CVS Health (Harrisburg, PA)
- …payment through identification of disallowed billed charges through Internal Itemized Bill Review . This Nurse Coder position reviews hospital itemized bills to ... both internal payment policies and Medicare payment policies the Nurse Coder ensures all billed line items align with...review of routine to complex high dollar facility claims . + Communicate with various levels of Network Management… more
- GEHA (Lee's Summit, MO)
- …personalized customer experience, sustained by a nimble and efficient organization. The Nurse Consultant II provides professional nursing care to our members through ... of the member on how to close those gaps, review of clinical history, and review of...and/or clinical and/or plan policy development and management. The Nurse Consultant II will be involved in research and… more