- Elevance Health (Atlanta, GA)
- …and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
- CVS Health (Petersburg, VA)
- …areas. Requirement is for candidates to hold a current unrestricted Virginia state RN licensure. Nurse Case Manager is responsible for assessing, planning, ... each and every day. **Position Summary** This Case Manager RN position is with Aetna's Long-Term Services & Support...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- Packing Corp of America (Tomahawk, WI)
- …and limited risk to re-injury. Position Requirements: + Education: Must be licensed as a registered nurse in the State of Wisconsin and have a high school ... The Nurse must maintain relationships with internal and external customers. The Nurse is the facility's medical professional and employees rely on the … more
- CVS Health (Bassett, VA)
- …we do it all with heart, each and every day. **Position Summary** Nurse Case Manager is responsible for assessing, planning, implementing and coordinating all case ... management activities with members to evaluate the medical needs of the member to facilitate the member's...policies. Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit… more
- LA Care Health Plan (Los Angeles, CA)
- …case management referrals (5%) Performs prospective, concurrent, post-service, and retrospective claim medical review processes. Utilizes clinical judgement, ... requirements for health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted… more
- Centene Corporation (Helena, MT)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Perform clinical/coding medical claim review to ensure compliance with coding ... practices through a comprehensive review and analysis of medical claims...coding, coding/data analysis, accounting/business or physician/hospital data management or RN /LPN and 2+ years of related clinical experience. Experience… more
- CVS Health (Trenton, NJ)
- …applicant's home). Standard working hours Monday - Friday 8-5 pm **ICM Case Manager RN ** **WFH Flexible** **Position Summary:** Help us elevate our patient care to a ... 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
- 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. 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
- Veterans Affairs, Veterans Health Administration (San Diego, CA)
- …State Veterans Home Liaison, Administrative Assistant, Administrative staff for review of eligibility, authorizations and scheduling etc., Registered ... refer to Required Documents below. The Jennifer Moreno DVA Medical Center in beautiful San Diego, California is looking...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more