- Sutter Health (Roseville, 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
- CVS Health (Lansing, MI)
- …implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. * ... 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
- CVS Health (Trenton, 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
- McLaren Health Care (Indianapolis, IN)
- …This includes but is not limited to the following: participates in the medical management of members in assigned product lines, including case specific and disease ... of high risk, and under and overuse of services. Collaborates with Medical Director and senior management on complex cases and special projects. **This… more
- Guthrie (Binghamton, NY)
- …knowledge of Guthrie Health System process improvement. + Denials Adjudication 1. Facilitate review of rejected medical claims using clinical evidenced based ... Summary The Registered Nurse (RN) Utilization Management (UM) in collaboration with...and related UM requirements preferred. Experience with CPT/ICD coding, medical record or chart auditing, and experience in utilization… more
- Sedgwick (Oklahoma City, OK)
- …review process including making a recommendation of specialty for the Independent Medical Review process. + Developing and delivering training materials and ... Best Workplaces in Financial Services & Insurance Sr. VP Medical Director **PRIMARY PURPOSE** **:** To evaluate medical...the following: + Conducting reviews on cases where the nurse is seeking treatment plan clarification, claim … more
- Robert Half Accountemps (Dallas, TX)
- … medical or coding denials to the QA Department for nurse review and appeal. * Demands claims for secondary insurance filing and copies explanation ... from the date of service. Perform appeals for underpaid claims or claim denials as assigned by...proper confidentiality on all such information. * Knowledge of medical terminology, CPT and ICD-10 coding, office ethics, 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
- Sedgwick (West Hills, CA)
- …professional needs. **PRIMARY PURPOSE** : Provides disability case management and routine claim determinations based on medical documentation and the applicable ... system. + Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims . + Evaluates and arranges appropriate… more