- 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 ... conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You'll… 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 ...REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered Nursing.… more
- US Tech Solutions (Columbia, SC)
- …Utilizes available resources to promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for ... appeals requests using Medicare criteria. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …software for financial care activities including eligibility verifications, pre-authorizations, medical necessity, review /updating of patient accounts, etc. * ... *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-… 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 ... coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care initial… 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 ... guidelines to determine the appropriate level of care and the medical necessity of continued hospitalization. Secures initial payer authorization and continued… 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 ... and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second level review and… more
- Centene Corporation (Little Rock, AR)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... on workplace flexibility. **Position Purpose:** Drafts correspondence letters based on review outcomes in accordance with National Committee for Quality Assurance… more
- 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 ... company policies and procedures. + Research unclear and unusual claims . Essential Skills + Registered Nurse (RN)...(RN) license required. + 3+ years of experience in medical record review , billing, and auditing. +… more
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