- Elevance Health (Mendota Heights, MN)
- …enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently ... Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator Senior** is responsible for the independent… more
- University of Virginia (Culpeper, VA)
- …as an Advance Practice Provider ( Nurse Practitioner, Physician Associate, Certified Registered Nurse Anesthetist, and Certified Nurse Midwife) as set ... the state of Virginia. If Nurse Practitioner, license to Practice as a Registered Nurse in the Commonwealth of Virginia is required. Must demonstrate and… more
- Highmark Health (Camp Hill, PA)
- …of external client facing **LICENSES or CERTIFICATIONS** **Required** (any of the following) + Registered Nurse ( RN ) + Physician Assistant License - PA + ... clinical subject matter expert for clinical, quality, care, utilization, high cost claim and population health management as the part of the clinical presentations… more
- Catholic Health (Buffalo, NY)
- …finance, business management, operational analysis, information systems or related field + Registered Nurse with a four (4) year degree and Unrestricted ... for the people, carrying out and documenting the appeals process for denied claims denied due to reasons including, but not limited to clinical documentation/support… more
- Arnot Health (Elmira, NY)
- …Auth/Denial Management meetings EDUCATION: RN required. EXPERIENCE: NYS licensed Registered Nurse required. Bachelor's in nursing preferred. Must have ... Case Managers! MAIN FUNCTION: The Case Management (denial/prior auth) will review and appeal as appropriate for concurrent and retrospective authorization and… more
- Independent Health (Buffalo, NY)
- …exceptional customer service to all internal and external customers. **Qualifications** + Registered Nurse ( RN ) with active, current, unrestricted NYS ... Two (2) years of case management or clinical experience in acute medical /surgical/critical care or ambulatory setting required. + Proficient computer and Windows… more
- Hartford HealthCare (Farmington, CT)
- …highly skilled technical staff that has certified coders to correct and resolve claim and denial issues. In addition, the department includes a team of Revenue ... Cycle departments and Information Technology. Our objective is to assure a clean claim is produced. Our teams are located, on-site or remotely. Our primary location… more
- Veterans Affairs, Veterans Health Administration (Aurora, CO)
- …anesthesia care alone or supervises physicians in-training (residents) or certified registered nurse anesthetists. When working alone, he/she examines the ... determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.… more
- Veterans Affairs, Veterans Health Administration (Aurora, CO)
- …anesthesia care alone or supervises physicians in-training (residents) or certified registered nurse anesthetists. When working alone, he/she examines the ... meets the following conditions to demonstrate sufficient personal and identifiable medical services to the patient to exercise full, personal control over… more
- CareFirst (Baltimore, MD)
- …+ Proficient in Microsoft Office programs. **Licenses/Certifications Required Upon Hire** : Health Services\ RN - Registered Nurse - State Licensure and/or ... and pursues a responsive system for authorization of services and approved claims . + Prepares retrospective reviews, case appeals, billing coordination, and clinical… more