- GE Vernova (Oakbrook Terrace, IL)
- …materials; establish procurement schedules and conduct periodic progress monitoring. Oversee claim management with suppliers and regularly update suppliers on cash ... milestone recognition related to procurement. Report monthly progress, supplier claims , and project cost summaries to relevant stakeholders. Support compliance… more
- LA Care Health Plan (Los Angeles, CA)
- …health risk assessment (HRA), risk stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health Homes ... additional service needs according to specific program guidelines. Uses claims processing and care management software to look up...such as at the LA Care Community Resource Centers, medical clinics, and member homes. Duties Continued Meets and… more
- Elevance Health (Washington, DC)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,… more
- MD Anderson Cancer Center (Houston, TX)
- …They possess advanced clinical judgment and are adept at providing direct medical care within their scope of practice, including comprehensive health assessments, ... providers with their patients with glycemic disorders. PROVIDE DIRECT MEDICAL SKILLS WITHIN SCOPE OF PRACTICE Provide medical...Use judgment to work autonomously as defined by the nurse practice act or to collaborate with the healthcare… more
- San Antonio Behavioral Health (San Antonio, TX)
- …hospital admissions and extended hospitals stays. Completing data collection of demographics, claim and medical information; non- medical analysis; and ... The Utilization Review Coordinator conducts utilization reviews to determine if...Essential Duties: + Collaborate and set standards with registered nurse (RN) case managers (CMs) and outcome managers to… more
- Veterans Affairs, Veterans Health Administration (St. Cloud, MN)
- …FSWG members and others as appropriate. Facilitating and participating in VA medical facility surgical mortality and morbidity review conferences. Collaborating ... in the practice of surgery in an Operating Room setting at the VA medical facility. Provides leadership and oversight to ensure effective management of the Facility… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Nurse Manager of Oncology Clinic & Infusion Center Operations, TOG West Full Time, 80 Hours Per Pay Period, Day Shift Clinical Oncology Nurse manager ... ongoing quality improvement. Thompson Oncology Group (TOG) is a leader in medical oncology services and provides patients access to all proven, drug-based treatments… more
- Nuvance Health (Danbury, CT)
- …Appeals:* * *Root Cause Analysis:* Lead a specialized team to thoroughly investigate claims denied for medical necessity on bedded patients, identify root causes ... conversion rates, medical necessity outreach, and feedback to the utilization review team on denial outcomes. * *Discharge Planning & Social Work:* *… more
- Highmark Health (Pittsburgh, PA)
- …operational areas regarding issues related to supported technology. Manage utilization review , translation of foreign claims , coordination of benefits (COB), ... Allegheny General Hospital assists patients and their support systems in managing medical conditions effectively. Our team of talented Case Managers aims to… more
- Prime Therapeutics (Salem, OR)
- …and compelling communications + Knowledge and understanding of pharmacy and medical claims processing environment **Preferred Qualifications** + Certified Fraud ... and/or prescriber fraud, waste and abuse (FWA). This position conducts claims data mining, fraud analysis and auditing/monitoring activities and proactively… more