- 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
- Catholic Health Services (Smithtown, NY)
- …coding and billing of resident care services to maximize reimbursement. + Claim Review : Review and analyze submitted claims for accuracy and identify ... care center; 296-bed not-for-profit community hospital and a 60,000 square foot medical office building. Our nurses, physicians and support staff are devoted to… more
- Highmark Health (Pittsburgh, PA)
- …operational areas regarding issues related to supported technology. Manage utilization review , translation of foreign claims , coordination of benefits (COB), ... Allegheny General Hospital assists patients and their support systems in managing medical conditions effectively. Our team of talented Case Managers aims to… more
- Houston Methodist (Webster, TX)
- …assigned patient population, under the direct supervision of a Physician, APP and/or Registered Nurse . This position oversees appropriate scope of practice, (ie ... patients visiting the clinic under the direct supervision of a Physician, Registered Nurse , or clinic leadership procedures. Complete pre-visit planning workflow… more
- Aveanna Healthcare (Huntsville, AL)
- Home Health RN PT Executive Director ApplyRefer a FriendBack Job Details Requisition #: 207910 Location: Huntsville, AL 35806 Category: Nursing Salary: $95,000.00 - ... Aveanna's policies and procedures. **We are open to an RN or Physical Therapist for this position. This role...+ Plan and implement branch growth strategies + Thorough review of financial statements, activity reports, and other performance… more
- Aveanna Healthcare (Miami, FL)
- Home Health RN Executive Director of Operations ApplyRefer a FriendBack Job Details Requisition #: 208380 Location: Miami, FL 33166 Category: Nursing Salary: ... Management/Issue Resolution * Plan and implement branch growth strategies * Thorough review of financial statements, activity reports, and other performance data to… more
- Aveanna Healthcare (Sioux Falls, SD)
- Home Health RN Executive Director ApplyRefer a FriendBack Job Details Requisition #: 207805 Location: Sioux Falls, SD 57105 Category: Nursing Salary: $80,000.00 - ... * Plan and implement branch growth strategies * Thorough review of financial statements, activity reports, and other performance...if internal billing and collection efforts to generate clean claims * Perform other duties as assigned Why Join… more
- Commonwealth of Pennsylvania (PA)
- …one year of hire. + This position requires active authorization to practice as a Registered Nurse in Pennsylvania. + If you possess an active temporary practice ... will write reports on survey and investigation findings and review plans of correction for necessary components to plan...permit, you must obtain licensure as a Registered Nurse within the one (1) year… more