- Molina Healthcare (Warren, MI)
- …set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, ... state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure… more
- Commonwealth Care Alliance (Boston, MA)
- …to the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will be responsible for providing ... **Essential Duties & Responsibilities:** + Primary responsibility for performing daily medical reviews, appeals as appropriate, correspondence regarding review … more
- Penn State Health (Reading, PA)
- …and family medical or genetic information._ **Position** RN Registered Nurse Patient Safety/Peer Review /Mortality - Quality Services **Location** ... medical staff clinical quality professional practice evaluation. Perform review of medical records based...experience required + Currently licensed to practice as a registered nurse by state of employment or… more
- AdventHealth (Ocala, FL)
- …the analysis of events that require peer review and the examination of medical records as identified by clinical indicators or triggers is an integral part ... The Coordinator Professional Practice Evaluation is responsible for facilitating the medical staff Peer Review , Ongoing Professional Practice Evaluation (OPPE)… more
- Vighter Medical Group (Killeen, TX)
- Flight Registered Nurse ( RN ), Killeen, TX (FT)...to their countries of origin. The RN will review medical records to determine if ... - Killeen, TX Position Type Full Time Education Level Registered Nurse ( RN ) Travel Percentage...Customs Enforcement. Healthcare is delivered in accordance with approved medical protocols and in compliance with Department of Homeland… more
- Actalent (Des Moines, IA)
- Job Title: Post Review Nurse - Utilization Management Job...using InterQual criteria and medical policy. + Review medical records for suspended ... Description We are seeking a diligent and detail-oriented Post Review Nurse to perform timely utilization management...claims assessments. This role involves applying InterQual criteria and medical policy to evaluate medical records… more
- HonorHealth (AZ)
- …Registered Nurse in an acute care setting - RequiredLicenses and Certifications Registered Nurse ( RN ) State And/Or Compact State Licensure - Required ... across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of health care… more
- Houston Methodist (The Woodlands, TX)
- …registered nurse ( RN ) who comprehensively conducts point of entry and concurrent medical record review for medical necessity and level of care ... determines the appropriateness of inpatient or observation services following review of relevant medical documentation, medical...in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- Henry Ford Health System (Grand Blanc, MI)
- Registered Nurse - Medical ...tests ordered are expeditiously carried out and documented. + Review patient medical record /reports and ... will be considered the official job description. Education/Experience Requirements + Licensed Registered Nurse credentialed from the Michigan Board of Nursing… more
- Children's Mercy Kansas City (Kansas City, MO)
- …experience + Experience in Utilization Review + One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire ... of patients, including patient statusing processes, ongoing monitoring of medical necessity review functions utilizing InterQual and/or...+ One of the following: Licensed RN - Kansas, Registered Nurse … more
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