- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …software for financial care activities including eligibility verifications, pre-authorizations, medical necessity, review /updating of patient accounts, etc. * ... We are currently seeking a*RCM Representative Senior*to join our Third-Party Claims -HB&PB team. This full-time role will primarily work remotely (Days, M-… more
- Idaho Division of Human Resources (Nampa, ID)
- Utilization Review and Nurse Educator - SHW Posting Begin Date: 2025/09/22 Posting End Date: 2025/10/20 Category: Nursing Work Type: Full Time Location: Nampa, ... found here: https://dhr.idaho.gov/StateEmployees/Benefits.html.* EXAMPLE OF DUTIES: + Coordinate Utilization Review Services to assess medical necessity, level… more
- CDPHP (Latham, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care initial… more
- Centene Corporation (New York, NY)
- …RN Licensure as well as a State Issued NY ID.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all outpatient ... and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review and… more
- Lincoln Financial (Columbia, SC)
- …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
- AdventHealth (Riverview, FL)
- …be caring for:** AdventHealth Riverview AdventHealth is expanding our medical expertise, innovation, and state-of-the-art technology to southern Hillsborough County ... million project in Riverview also includes a 100,000 square foot, four-story Medical Office Building that will provide community members convenient access to expert… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical … 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
- State of Georgia (Fulton County, GA)
- …additional experience in the analysis of medical services documentation and related claims 2) Utilization Review 3) Case Management 4) Analysis of CPT codes ... Nurse Investigator Georgia - Fulton - Atlanta (https://ga.referrals.selectminds.com/jobs/64040/other-jobs-matching/location-only)...clinical experience AND one (1) year experience working with medical claims . Preference will be given to… more
- Veterans Affairs, Veterans Health Administration (San Diego, CA)
- …For more information, refer to Required Documents below. The Jennifer Moreno DVA Medical Center in beautiful San Diego, California is looking to hire an Associate ... State Veterans Home Liaison, Administrative Assistant, Administrative staff for review of eligibility, authorizations and scheduling etc., Registered Nurses (RNs)… more