- Zurich NA (Schaumburg, IL)
- …Qualifications: + 2 or more years' experience in Utilization Review , Case Management, Workers Compensation, or medical bill reviews + Strong communication ... our Schaumburg, IL office. With limited direction, reviews highly complex medical billing, including more difficult ...standard work practices to ensure compliance. + Monitor and review complex billing information, updating where necessary… more
- Bassett Healthcare (Cooperstown, NY)
- …+ Uses data collection tools to reflect activities, as noted by review of documentation + Provides community resource information as requested and facilitates ... date + Assists C3s with referrals; faxes and photocopies medical record information as needed for post-acute patient placement...to facilitate timely discharges + Support Unit C3s and Complex C3s with setting up transport, DME, and Follow-up… more
- Sandia National Laboratories (Livermore, CA)
- …of onsite work and working from home) + Generous vacation, strong medical and other benefits, competitive 401k, learning opportunities, relocation assistance and ... Team (PRT). This PRT Integration Lead role will require review and critique of technical development efforts by a...with mechanical engineering and product realization in the NNSA complex . + Strong verbal and written communication skills, ability… more
- CenterWell (Las Vegas, NV)
- …other duties and responsibilities as required . Participate in and lead interdisciplinary review of and coordination around complex patients . Maintain patient ... and supportive consultation to other team members, handling escalated complex cases . Develop care plans leveraging 5Ms Geriatric...in accordance with HIPAA . Document patient encounters in medical record system in a timely manner . Follow… more
- CVS Health (Columbus, OH)
- …Join a team that's making a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing ... in Medical Review , you'll play a vital role...in Medical Review , you'll play a vital role in ensuring members...feedback. + Actively cross-trains to perform reviews of multiple case types to provide a flexible workforce to meet… more
- Gilead Sciences, Inc. (Foster City, CA)
- …company that discovers, develops and commercializes innovative medicines in areas of unmet medical need. We strive to transform and simplify care for people with ... centric, science focused company. Reporting to the Executive Director of Global Medical Affairs Technology, this individual will be responsible for driving delivery… more
- Evolent (Helena, MT)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek… more
- ChenMed (Norfolk, VA)
- …departments, and other healthcare facilities. + In conjunction with the PCP, Hospitalist, Medical Director, insurance case manager and the hospital case ... need great people to join our team. The Nurse Case Manager 1 (RN) is responsible for achieving positive...studies and special projects as assigned. + Conducts concurrent medical record review using specific indicators and… more
- The Cigna Group (Bloomfield, CT)
- …-- Cigna. **Summary description of position** : A Medical Principal performs medical review and case management activities. The physician provides ... not be included in CMS' Preclusion List** **Preferred Skill Sets:** + Experience in medical management, utilization review and case management in a managed… more
- Community Health Systems (Franklin, TN)
- … necessity, discharge planning, and payer requirements. + Documents all utilization review activities in the hospital's case management software, including ... reconsiderations or coordinating peer-to-peer reviews. + Communicates effectively with utilization review coordinators, case managers, and discharge planners to… more