- Trinity Health (Maywood, IL)
- …campus. Position is hybrid, must reside in Illinois. The **Regional Utilization Review Documentation Specialist** nurse works with the multidisciplinary team ... **Employment Type:** Full time **Shift:** Day Shift **Description:** Utilization Review - RN Reviewer- Regional Coverage for Loyola, Gottlieb and MacNeal Hospitals.… more
- WFF Facility Services (Knoxville, TN)
- …and frequent status updates to Claims Manager throughout the life of assigned claims . * Participate in claims review and compile monthly/quarterly status ... Job Objective Workers Compensation Analyst processes and manages Workers' Compensation claims , investigates claims , and promotes sound decisions regarding … 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
- U-Haul (Phoenix, AZ)
- …relationships with TPAs, excess carriers, brokers and internal stakeholders to ensure claim efficiency. + Review and approve vendor invoices and third-party ... are handled in accordance with state laws and company claim standards. This position involves the supervision of staff...We're Looking For: + In-depth knowledge of WC laws, claims handling, and medical /litigation processes, with experience… more
- US Tech Solutions (Columbia, SC)
- …Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. + Performs ... A typical day would like in this role: reviewing claims for medical necessity/reviewing cam policies for non-covered... medical claim reviews for one or… more
- Medical Mutual of Ohio (OH)
- Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million ... planning coordination and facilitation. Works with IT and Clinical Nurse staff to aid in the loading of HEDIS...in the loading of HEDIS data and collection of medical records. Works closely with HEDIS vendor support to… more
- Zelis (FL)
- …Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest ... plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records...concepts to expand the DRG product. + Manage assigned claims and claim report, adhering to client… more
- Blue KC (Kansas City, MO)
- …academic discipline. 1 years investigative experience in the following areas (eg, medical review , financial, medical analytics, research & adjustment, ... findings and recommendations. Present reports to key stakeholders (eg, Provider Relations, Medical Management, Pharmacy, Claims , Legal) + Assist in coordinating… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …to determine clinical appropriateness. * Completes review of both medical documentation and claims data to assure appropriate resource utilization, ... You Will Have This job implements effective utilization management strategies including: review of appropriateness of pre and post service health care services,… more
- GEHA (Lee's Summit, MO)
- …simple cases that require review by Medical Director, Pharmacist or nurse . + Interprets medical review results to determine compliance with contract ... clinical and business need. + Coordinates, reviews and investigates claims to determine the medical necessity and...receive correspondence from someone at GEHA, we recommend you review the following facts to help verify if someone… more