- 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
- Diversicare Healthcare Services & Diversicare Ther (Bessemer, AL)
- …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 (Canoga Park, 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 91304 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
- TEKsystems (Canoga Park, CA)
- …hire an experienced RN or LVN with an active license to help address claims retro review . This role focuses on reviewing inpatient and outpatient claims ... Key Responsibilities: + Perform detailed utilization reviews for inpatient and outpatient claims . + Prepare medical records for medical directors… more
- TEKsystems (Canoga Park, CA)
- …Perform comprehensive utilization reviews for inpatient and outpatient claims . + Prepare medical records for review by medical directors and provide ... We are seeking a detail-oriented and experienced RN or LVN with an active license to join our team...you will conduct retrospective reviews of inpatient and outpatient claims to ensure medical necessity, compliance, and… more
- US Tech Solutions (Columbia, SC)
- …following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a reasonable charge ... protocol sets or clinical guidelines. + Provides support and review of medical claims and...families/caregivers. Reviews first level appeal and ensures utilization or claim review provides thorough documentation of each… more
- US Tech Solutions (Columbia, SC)
- …following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a reasonable charge ... indicated protocol sets or clinical guidelines. Provides support and review of medical claims and...+ Reviews first level appeal and ensures utilization or claim review provides thorough documentation of each… more
- Sedgwick (San Antonio, 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
- 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