- LA Care Health Plan (Los Angeles, CA)
- … and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. ... Nurse Coder RN III Job Category: Clinical Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position...team lead on any issues identified during research or claims review . Applies subject expertise in evaluating… more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of the ... RXs, Care in the Community, DME, and Ambulance. Conducts clinical legal relatedness review for Regional Counsel TORT Claims , No Fault, and Worker's Compensation… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry ... and concurrent medical record review for medical ...claim issues or concern that may require clinical review during the pre-bill, audit, or appeal process. +… 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
- Chenega Corporation (Rockville, MD)
- …compensation programs, or managed care. + Professional Background: Relevant experience in claims review , healthcare administration, or related fields. + A ... program knowledge, leadership, and/or support experience. + Must have experience in claims review , healthcare administration, or related fields. + Must have… more
- Ventura County (Ventura, CA)
- …patient-centered care. Under general direction, the Senior Medical Management Nurse is responsible for performing utilization review , case management, and ... Senior Medical Management Nurse - VCHCP Print...are not limited to the following: + Performs utilization review with pre-certification, concurrent, retrospective, out of network and… more
- MD Anderson Cancer Center (Houston, TX)
- …third-party payers, insurance medical directors, case management, and utilization review to request reconsideration and/or appeal of claims requiring ... As a * Nurse Defense Auditor* in our *Hospital Billing &...appeal timelines. * Maintain understanding of insurance guidelines for medical necessity review , including M&R and InterQual,… more
- Centene Corporation (New York, NY)
- …license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for ... and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review and… more
- Beth Israel Lahey Health (Burlington, MA)
- …not just taking a job, you're making a difference in people's lives.** RN - Employee Health Nurse - Lahey Medical Center - Burlington, MA. 32 hrs. Days M-F. RN - ... Employee Health Nurse - Lahey Medical Center - Burlington,...**Job Description:** 1. Conducts initial post-offer/pre-placement physical assessment, including review of immunization status, and provides required testing or… more
- Ascension Health (Tulsa, OK)
- … claims , qualityindicators and other risk-related data. + Coordinate the medical staff's professional performance evaluation and peer review programs in ... and corrective action where appropriate. + Collaborate in any investigative, judicial review or appeal process involving medical or allied health staff… more