- 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
- 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
- Geisinger (Wilkes-Barre, 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 ... clinical risk management as part of the System's Peer Review process. Performs all duties in a manner that...support for patients. At least 5 years of Registered Nurse work experience is required. BSN is required. The… 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
- 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
- US Tech Solutions (Columbia, SC)
- …available resources to promote quality, cost effective outcomes. + Performs medical or behavioral review /authorization process. Ensures coverage for appropriate ... first 1-2 weeks remote position after training. + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying… more
- CVS Health (Haddonfield, NJ)
- …and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. The ... to enhance a member's overall wellness. + Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits. + Applies clinical… more
- Abbott (Temecula, CA)
- …spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 114,000 colleagues ... you dream of. + Employees can qualify for free medical coverage in our Health Investment Plan (HIP) PPO..., currently has an opportunity for a **Occupational Health Nurse .** **What You'll Work On** Provides for and delivers… more
- Elevance Health (Norfolk, VA)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope… more
- Elevance Health (Atlanta, GA)
- **Telephonic Nurse Case Manager I** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager I** is responsible for telephonic care...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisor's on the development of… more