- Sutter Health (Sacramento, CA)
- …quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and ... experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely progression and… more
- Sutter Health (Burlingame, CA)
- …quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and ... experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely progression and… more
- Sutter Health (San Francisco, CA)
- …quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and ... experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely progression and… more
- CVS Health (Royal Oak, MI)
- …and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. Join ... all case management activities with members to evaluate the medical needs of the member to facilitate the member's...member's overall wellness. + Uses clinical tools and information/data review to conduct an evaluation of member's needs and… more
- US Tech Solutions (Columbia, SC)
- …records review , outcomes, trends, and savings that directly impact medical costs and contracting rates. + Manages records retrieval, release, HIPAA compliance, ... 3 years medical record management to include coding and validation review experience. **Skills:** + Develops methodologies + Follows processes + Responds to… 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
- CVS Health (Wayne, NJ)
- …and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. Help ... a whole new level! **Key Responsibilities** + Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits. + Applies… more
- Elevance Health (Indianapolis, IN)
- …of the care management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of care management treatment ... rates of reimbursement, as applicable. + Assists in problem solving with providers, claims or service issues. **Minimum Requirements:** + Requires BA/BS in a health… more
- Access Dubuque (Dubuque, IA)
- …solution-focused. **PRIMARY PURPOSE** : Provides disability case management and routine claim determinations based on medical documentation and the applicable ... your 2+ years' experience in a office setting or medical experience and grow with us! + A stable...system. + Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims . + Evaluates and… more
- Sedgwick (Dubuque, IA)
- …solution-focused. **PRIMARY PURPOSE** : Provides disability case management and routine claim determinations based on medical documentation and the applicable ... your 2+ years' experience in a office setting or medical experience and grow with us! + A stable...system. + Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims . + Evaluates and… more