- Dana-Farber Cancer Institute (Brookline, MA)
- …experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. ... to help resolve more complex inquiries. + Assists Drug Authorization Specialists with medical necessity denial review : + Ensures that all necessary medical… more
- Wellpath (Centennial, CO)
- …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
- CVS Health (Austin, TX)
- …do it all with heart, each and every day. **Position Summary** This Case Manager RN role is with the Costco Team and is fully remote; however, candidates must reside ... or holidays will be required** . The Case Manager RN is responsible for telephonically and/or face to face...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- Beth Israel Lahey Health (Milton, MA)
- …Occupational Health Nurse preferred. **LICENSE, CERTIFICATION REQUIRED:** Massachusetts Registered Nurse license. Certification as an Occupational Health ... provides occupational health care services to employees. **Job Description:** ** RN - Employee Health Nurse - BID-Milton...+ At least three years work experience as a medical or surgical staff nurse . + Certified… more
- Sedgwick (Tampa, FL)
- … review of referred claims ; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. ... + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made on claims .… more
- CDPHP (Latham, NY)
- …coding of risk adjustment eligible members. This position will have responsibility for review of medical records to identify accurate ICD-10 diagnosis codes, ... or CPC/CPC-A (Certified Coding Professional) required. If CCA or RN /LPN licensure, successful completion of AHIMA CCS/CCS-P or AAPC...of medical terminology, anatomy and physiology, and medical chart review required. + Knowledge of… more
- CVS Health (Frankfort, KY)
- …do it all with heart, each and every day. **Position Summary** The Complex Nurse Case Manager is responsible for assessing members through regular and consistent in ... implement and coordinate all case management activities with members to evaluate the medical and psychosocial needs of the member to facilitate and support the… more
- NJM Insurance (Parsippany, NJ)
- …with other members of the Medical Management team in addition to the WC Claims team, WC Claims Supervisors, and other team members. The official NJM job ... statutory, regulatory, licensing requirements, and NJM policies/guidelines that affect utilization review , case management, and medical management. + Evaluate… more
- St. Luke's University Health Network (Allentown, PA)
- …Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks outcomes regarding appeal process. Assists billing staff ... outpatient denials for experimental, coding or other issues that may require record review . Provides billing with information needed to obtain payment of claims .… 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, ... improve provider performance and member satisfaction. Required Skills and Experience * Registered nurse or licensed behavioral health clinician (ie LICSW, LPCC,… more