- HCA Healthcare (Englewood, CO)
- …**What qualifications you will need:** Current licensure in the State of Colorado as a Registered Nurse , or current active multistate Registered Nurse ... join an organization that invests in you as a(an) RN Case Mgr Rehab PRN? At HCA HealthONE Swedish,...colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no… more
- TEKsystems (Canoga Park, CA)
- …adjudication. This role is ideal for a Licensed Vocational Nurse (LVN) or Registered Nurse ( RN ) with hands-on experience in Utilization Management (UM) ... Claims Reviewer is responsible for auditing and reviewing medical claims to ensure accuracy, regulatory compliance,...errors + Ensure HIPAA and PHI compliance throughout all claim review activities + Participate in special… more
- Highmark Health (Little Rock, AR)
- …+ 1-3 years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related ... rejection and the proper action to complete the retrospective claim review with the goal of proper...Review process includes a review of medical documentation, itemized bills, and claims data… more
- Covenant Health Inc. (Knoxville, TN)
- …Access.Oncology and healthcare leadership experience preferred. Licensure Requirement: Current state registered nurse license. Certified Oncology Nurse ... Overview Nurse Manager of Oncology Clinic & Infusion Center...combination in healthcare management, business or other related field. RN , Pharmacist, or Medical Technologist strongly preferred.BSN… more
- Billings Clinic (Billings, MT)
- …be considered Certifications and Licenses * Current Montana state license as a registered nurse At hire * Certified Professional in Healthcare Risk Management ... all full- and part-time employees (minimum of 20 hours/week), including Medical , Dental, Vision, 403(b) Retirement Plan with employer matching, Defined Contribution… more
- Wellpath (Franklin, TN)
- …information in ERMA Care Management and Track Via systems, ensuring compliance with claims and medical review procedures. + Manage pre-certification ... **Perks and Benefits** In addition to comprehensive benefits including medical , dental, vision, paid time off, and 401k, we...accredited School of Nursing or Care Management Certification + RN preferred EXPERIENCE + Previous utilization review … more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …care coordination, and transition of care between settings. Required Skills and Experience * Registered nurse with current MN license and with no restrictions. * ... Cross and Blue Shield of Minnesota Position Title: Care Advocacy Case Manager RN - Bilingual Spanish Location: Remote Career Area: Health Services About Blue Cross… more
- Sutter Health (Oakland, CA)
- …an accredited school of nursing Required + BSN Preferred **CERTIFICATION & LICENSURE** + RN - Registered Nurse of California Required + Certified Case Manager ... position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to...services, third party payers and review agencies, claims and finance departments, Medical Directors, and… more
- Spira Care, LLC (Kansas City, KS)
- …Minimum Qualifications + Associate or bachelor's degree in nursing + Valid and active Registered Nurse ( RN ) in Kansas and Missouri or multi-state compact ... include: + Highly competitive total rewards package, including comprehensive medical , dental and vision benefits as well as a...helping people achieve their health goals. The Care Guide, RN is an integral role within the Care Team… more
- Centene Corporation (New York, NY)
- …establish processes to respond to ICD-10 coding changes and its effect on inpatient claims payment. Chart review will include DRG pre-payment review , ... hospital readmission review and outlier payment review . + Analyze moderately complex health care information; reviews...requirements are adhered to for the appropriate handling of medical necessity, claims denials, and bundling issues.… more