- Centene Corporation (Queens, NY)
- …terminology such as ICD 10 codes, medical abbreviations, medications. Experience in medical records review , claims processing or utilization and case ... Quality Assurance RN will work in various capacities to review , monitor and train staff in the Long Term...order to ensure that all components of the Member's medical record are completed with quality standards and accuracy… more
- Elevance Health (Chicago, IL)
- …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 Payment Integrity SIU**...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
- InGenesis (Columbia, SC)
- …using established criteria or clinical guidelines. In this role, you will provide support and review of medical claims and utilization practices. This is a ... InGenesis is currently seeking a Licensed Practical Nurse / LPN to work remotely with our...regulations. * Completes authorization by following established policies * Review interdepartmental requests and medical information to… more
- Geisinger (Danville, PA)
- …As one of the Top 8 Most Innovative Healthcare Systems in Becker's Hospital Review , we're working to create a national model for improving health. Today, we're ... hours are available. At least 5 years of Registered Nurse work experience and a BSN is required. The...dental and vision) starting on day one + Three medical plan choices, including an expanded network for out-of-area… more
- CP Unlimited (Carmel, NY)
- Registered Nurse Type of Position Full time Search Location(s) Carmel, NY, Fishkill, NY, Garrison, NY, Poughkeepsie, NY, Yonkers, NY Apply Now ... (https://phe.tbe.taleo.net/phe03/ats/careers/v2/applyRequisition?org=CPOFNYS&cws=45&rid=6353) Job Brief The Registered Nurse shall provide health related services to individuals who… more
- Eastern Connecticut Health Network (Manchester, CT)
- …via career ladders, committee involvement, and more. POSITION SUMMARY: The Population Health Nurse is responsible for the review and implementation of clinical ... year! + Sick Time on an accrual basis + 401(k)/ Medical /Dental/Vision Insurance/Employee Assistance Program/Voluntary Benefit Options + Tuition Reimbursement-… more
- NHS Management, LLC (Fayetteville, AR)
- …risk management policies to include reviews of significant events/unusual occurrences and a review of the medical record. We offer the following benefits for ... way. We are in search of a qualified Regional Nurse Consultant: The Regional Nurse Consultant will...that need improvements or change. 3. Eliminate/reduce resident liability claims through use of corporate policies and established customer… more
- Travelers Insurance Company (New York, NY)
- …Utilize evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims . Provides quality claim handling throughout the claim… more
- CVS Health (Columbus, OH)
- …+ 3+ years clinical nursing experience, with 1-3 years managed care experience in Utilization Review , Medical Claims Review , or other specific program ... weekends depending on business needs** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in… more
- BronxCare Health System (Bronx, NY)
- …(according to the NPSG), intake screening of patient, pre-visit planning (if applicable), review of medical record to determine visit requirements such as HEIDS ... Overview Licensed Practical Nurse : Under the direct supervision of a physician...analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality… more