- Cognizant (Richmond, VA)
- …expectations. **What you need to have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...the medical necessity determinations to the Health Plan/ Medical Director based on the review of… more
- CVS Health (Farmville, VA)
- …it all with heart, each and every day. **Position Summary** This Case Manager Registered Nurse position is with Aetna's Long-Term Services and Supports (LTSS) ... The requirements is for candidates to hold an IL Registered Nurse or Behavioral Health License, and...the time to meet with members face to face. RN /BH Licensed Case Manager is responsible for assessing, planning,… more
- CVS Health (Richmond, VA)
- …communication skills, both verbal and written. + Bilingual in English/Spanish **Education** + Registered Nurse ( RN ) Licensure with minimum of an Associates ... all with heart, each and every day. **Position Summary** 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 (Annandale, VA)
- …current unrestricted Virginia state licensure required - 3+ years clinical experience as a Registered Nurse (ie med surg, behavioral health, acute care) - Must ... Areas- Haymarket, Gainesville, Centerville and Manassas. Monday-Friday Standard Business Hours. Nurse Case Manager is responsible for telephonically and/or face to… more
- CVS Health (VA)
- …Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... of residence.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS...setting. + A Registered Nurse that holds an active, unrestricted… 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...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
- Elevance Health (Richmond, VA)
- …and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a ... experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing… more
- Lincoln Financial (Richmond, VA)
- …**What we're looking for** Education * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where ... organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you… more
- HCA Healthcare (Hopewell, VA)
- …of Science in Nursing or related field - Required Master of Science - Preferred Registered Nurse License in state in which he or she practices - Required ... HCI, the Division Vice President of Quality, Division Chief Medical Officer, Division Claims Administrator, HCA Patient...and probability of legal action for submission of Probable Claim Report (PCR) to HCI. Balance Systems and Individual… more
- Elevance Health (Roanoke, VA)
- …enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently ... Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator Senior** is responsible for the independent… more