- CVS Health (Bassett, 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 ... talking on the telephone, and typing on the computer Nurse Case Manager is responsible for assessing, planning, implementing...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- CVS Health (Virginia Beach, 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
- US Tech Solutions (Richmond, VA)
- …advocacy. **Duties** + Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit plan eligibility and ... including co-morbid and multiple diagnoses that impact functionality. + Reviews prior claims to address potential impact on current case management and eligibility.… more
- University of Virginia (Fishersville, VA)
- UVA Augusta Pediatrics is seeking an Autonomous Licensed Psychiatric Nurse Practitioner for their practice in Fishersville, VA. 2-3 years of experience is required. ... credentialing dependent on specialty. * Works in conjunction with the medical director, administrative management, nursing and other interprofessional team members… more
- Elevance Health (Norfolk, VA)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- Sedgwick (Richmond, VA)
- …review process including making a recommendation of specialty for the Independent Medical Review process. + Developing and delivering training materials and ... Best Workplaces in Financial Services & Insurance Sr VP Medical Director (Hourly) The ideal candidate would work 8-20...the following: + Conducting reviews on cases where the nurse is seeking treatment plan clarification, claim … more
- CVS Health (Richmond, VA)
- …for guiding the team in determining correct coding and appropriate documentation during the review of medical records. This role requires a strong focus on ... coding reviews and resolve intricate issues with sensitivity, including claim reviews for legal, compliance, or rework projects. +...projects. + Ensure staff provide detailed written summaries of medical record review findings and ensure the… more
- Family Dollar (Chesapeake, VA)
- …and frequent status updates to Claims Manager throughout the life of assigned claims . + Participate in claims review and compile monthly/quarterly status ... position will play a key role in managing Family Dollar's workers' compensation claims . The ideal candidate will be a proactive problem-solver who can provide… more
- M. C. Dean (Vienna, VA)
- …decisions about liability/compensability, evaluating losses, managing relationship with the carrier claims adjuster, nurse case managers and stakeholders within ... and damages. + Assesses policy coverage for potential GAPS in coverage; review the established reserve requirements, identified claims for subrogation and/or… more
- HCA Healthcare (Reston, VA)
- …Assists appropriate medical staff and nursing committees in the resolution of peer review , medical quality of care and nursing quality of care issues posing ... and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low… more
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