- Actalent (West Des Moines, IA)
- …This role requires auditing and pricing a wide variety of claim types and identifying claims requiring further review . The Nurse Auditor will also maintain ... data and refer them to appropriate team members for review . + Maintain productivity work task goals, quality standards,...company policies and procedures. + Research unclear and unusual claims . Essential Skills + Registered Nurse (RN)… more
- Lincoln Financial (Denver, CO)
- …at a Glance** We are excited to bring on highly motivated Short Term Disability Claims Specialists to staff our ever-growing claims organization. As a Short Term ... home, then please read on! Click the following link Claims Specialist Job Preview (https://marketingmedia.lfg.com/lfg/DOCS/lfd/emailMarketing/Video/6369162297112.html) to see a realistic… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- US Tech Solutions (Columbia, SC)
- …or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare continuum to ... promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *SUMMARY:* We are currently seeking a*RCM Representative Senior*to join our Third-Party Claims -HB&PB team. This full-time role will primarily work remotely (Days, M- ... service and timely response to questions and issues related to benefits, billing, claims , payments, etc. * Answers questions (by phone and in-person) and provides… more
- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation ... exceptions, coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care… more
- Sedgwick (Raleigh, NC)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and colleague technical ... line of business experience in telephonic case management (TCM) and/or utilization review or equivalent combination of education and experience required. **Skills &… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, evidence-based guidelines, insurance ... to ensure authorizations and denials are addressed timely for clean claims submission. This position will participate in ongoing professional development activities,… more
- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more
- Centene Corporation (Little Rock, AR)
- …on workplace flexibility. **Position Purpose:** Drafts correspondence letters based on review outcomes in accordance with National Committee for Quality Assurance ... management to identify and implement opportunities for improvement. + Performs clinical review of outcomes including creating and editing denial letters with the… more
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