- Fallon Health (Worcester, MA)
- …in our service area, and who have MassHealth Standard, and may have Medicare . It combines MassHealth (Medicaid) and Medicare benefits, including prescription ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Learn more at fallonhealth.org… more
- Trinity Health (Davenport, IA)
- …(https://www.genesishealth.com/ghg/) Join the MercyOne Family! We are looking to hire a Registered Nurse ! As a Registered Nurse at MercyOne, you will provide and ... Families, and Significant Others, Vendors/Clients, Third Party Payors/Insurance Companies, Auditors/ Review Agencies + The job requires some accountability for… more
- Molina Healthcare (Dayton, OH)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more
- UPMC (Pittsburgh, PA)
- Are you an experienced nurse looking for the next challenge in your career? Do you have knowledge of care management or care coordination? Check out this fantastic ... UPMC Health Plan is hiring a full-time Telephonic Care Manager to support the Medicare line of business within the Allegheny Care Management Team. The position will… more
- Fallon Health (Worcester, MA)
- …integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of ... their dependence on the medical system. * Offers proactive review of members for a multidisciplinary care planning with...follow-up assessments with members and forward results to the Nurse Case Manager or PCP as indicated. Documents all… more
- Medical Mutual of Ohio (OH)
- …pre-employment substance abuse and nicotine testing._ **Title:** _Clinical Appeal & Claim Review Nurse II_ **Location:** _Ohio_ **Requisition ID:** _2500127_ ... self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans....care. + Extrapolates and summarizes medical information for physician review or other external review . + Generates… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure and/or Compact State Licensure...experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare , Medicaid,… more
- Martin's Point Health Care (Portland, ME)
- …as a "Great Place to Work" since 2015. Position Summary Job Description The Utilization Review Nurse works as is responsible for ensuring the receipt of high ... reviews for retrospective authorization requests as well as claims disputes.The Utilization Review Nurse will use appropriate governmental policies as well as… 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 ... administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one of the largest… more
- Hackensack Meridian Health (Eatontown, NJ)
- …for coding, OASIS and Hospice, and other clinical assessment tools as needed. + Review every Medicare and Managed Medicare admission chart to determine ... in the system if inappropriate codes are identified. + Review each Hospice assessment to assure each CTI, 485...of the certified operation, Hospice Clinical Director, and the Nurse Manager for the appropriate operation. Demonstrates the ability… more
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