- Lincoln Financial (Richmond, VA)
- …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
- University of Virginia (Louisa, VA)
- UVA Medical Associates of Louisa is seeking an Autonomous Licensed Psychiatric Nurse Practitioner for their practice in Louisa, VA. 2-3 years of experience is ... credentialing dependent on specialty. * Works in conjunction with the medical director, administrative management, nursing and other interprofessional team members… more
- CVS Health (Farmville, VA)
- …with heart, each and every day. **Position Summary** This Case Manager Registered Nurse position is with Aetna's Long-Term Services and Supports (LTSS) team and is ... requirements is for candidates to hold an IL Registered Nurse or Behavioral Health License, and travel 50-75% of...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- CVS Health (Annandale, VA)
- …Areas- Haymarket, Gainesville, Centerville and Manassas. Monday-Friday Standard Business Hours. Nurse Case Manager is responsible for telephonically and/or face to ... all case management activities with members to evaluate the medical needs of the member to facilitate the member's...policies. Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit… more
- CVS Health (Richmond, VA)
- …we do it all with heart, each and every day. **Position Summary** Nurse Case Manager is responsible for assessing, planning, implementing and coordinating all case ... management activities with members to evaluate the medical needs of the member to facilitate the member's...policies. Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit… more
- CVS Health (Louisa, VA)
- …extended periods, talking on the telephone, and typing on the computer Nurse Case Manager is responsible for assessing, planning, implementing and coordinating all ... case management activities with members to evaluate the medical needs of the member to facilitate the member's...policies. Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit… more
- CVS Health (Richmond, VA)
- …in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, ... Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members.… more
- Cognizant (Richmond, VA)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical… more
- Sedgwick (Richmond, VA)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Nurse Allocator- RN Medicare Compliance **Prior medical -set-aside experience highly ... **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, specialized document review , and analysis and interpretation of interventions for the preparation of… more
- Elevance Health (Richmond, VA)
- …and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU**...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more