- Emanate Health (Covina, CA)
- …decisions using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete ... States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity… more
- Prime Healthcare (Ontario, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/236094/utilization- review -nurse- lvn /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... qualifications: + Possess an active CA Licensed Vocational Nurse ( LVN ) license. + Minimum (2) two years of experience...work ethics. + Extensive knowledge of professional and hospital claims . + Extensive knowledge of coding, billing. + High… more
- Hartford HealthCare (Manchester, CT)
- … Medical Group Specialists* **Title:** *Population Health Nurse (LPN, LVN ) - Sign on bonus* **Location:** *Connecticut-Manchester-MMH-71 Haynes Street (10627)* ... $5K POSITION SUMMARY: The Population Health Nurse is responsible for the review and implementation of clinical workflows and processes within the ECMP physician… more
- Diversicare Healthcare Services & Diversicare Ther (Tupelo, MS)
- …and completes accurate coding of the MDS assessment with information obtained via medical record review , observation and interview with center staff, patients, ... and residents, **APPLY NOW!** **Full Time Benefits include:** + ** Medical /Dental/Vision** + **Excellent 401k plan** + **Tuition Reimbursement** + **Vacation,… more
- TEKsystems (Los Angeles, CA)
- …The Retro Claims Reviewer is responsible for auditing and reviewing medical claims to ensure accuracy, regulatory compliance, and proper adjudication. This ... Claims Reviewer Location: West Hills/Canoga Park 91305 Compensation: LVN $38-$40 hourly RN $45-$50 hourly Overview:...errors + Ensure HIPAA and PHI compliance throughout all claim review activities + Participate in special… more
- Sedgwick (Irving, TX)
- …the ADA process for claimants requesting accommodations under the ADAAA; to review complex medical information for temporary and permanent accommodation ... and/or client requirements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Reviews medical information for ADAAA temporary and permanent accommodation requests. +… more
- Elevance Health (Indianapolis, IN)
- …and/or utilization review experience. + Current active, valid and unrestricted LPN/ LVN or RN license and/or certification to practice as a health professional ... ** Medical Management Clinician Senior** **Location:** This role enables...scope of licensure. + These reviews may require in-depth review ; however, any deviation from application of benefits plans… more
- Veterans Affairs, Veterans Health Administration (Temple, TX)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... services through an interdisciplinary team that includes the PCP, RN care manager, LVN , clerical associate as well as other clinical services necessary to meet the… more
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- …of care). All Physicians are responsible to read and comply with the Medical Staff Bylaws. All physicians are responsible to timely complete all mandatory training. ... services through an interdisciplinary team that includes the PCP, RN care manager, LVN , clerical associate as well as other clinical services necessary to meet the… more
- Centene Corporation (Lansing, MI)
- …equivalent work experience within a managed care environment related to HEDIS record review , quality improvement, medical coding or transferable skill sets that ... performance in areas of Quality, Risk Adjustment and Operations ( claims and encounters). + Assists in delivering provider specific...Experience: Required: 1+ year of experience in related HEDIS medical record review or quality improvement with… more