- CareFirst (Baltimore, MD)
- …in addition to the required work experience. **Licenses/Certifications Upon Hire Required:** + RN - Registered Nurse - State Licensure And/or Compact ... & Qualifications** **PURPOSE:** We are looking for a Director, Medical Review & Appeals for our Government...Strategic Plan through direction and oversight of the Clinical Medical Claims Reviews, Clinical Appeals and Analysis… more
- System One (Baltimore, MD)
- …benefit eligibility and support claims processing/adjudication. It includes pre- and post- claim medical review for Commercial, FEP, and Medicare ... Job Title: Clinical Medical Review Nurse Location:...corporate and medical policies. Essential Functions + Claims Review & Analysis (35%) Review… more
- Molina Healthcare (Rio Rancho, NM)
- …At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports ... DESCRIPTION **Job Summary** Provides support for medical claim and internal appeals review activities -...or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must… more
- Houston Methodist (Katy, TX)
- …to department specifications. + Manages utilization management (UM) programs including Medical Claims Review , Precertification and Reconsiderations and ... performance that demonstrates progressive leadership abilities **LICENSES AND CERTIFICATIONS** **Required** + RN - Registered Nurse - Texas State Licensure… more
- InGenesis (Columbia, SC)
- InGenesis is currently seeking a Registered Nurse / RN - Managed Care Coordinator to work for our client located in Columbia, SC. In this role you will ... any questions you may have. Job Duties * Perform medical review /authorization process. * Ensure coverage for...Perform other duties as assigned. Minimum Qualifications * Current Registered Nurse / RN license… more
- Trinity Health (Columbus, OH)
- …information according to department policies and procedures. + Conducts claim review as required for appropriate claims processing. + Ability to implement ... with the Plan's UM and QM Program and the review of the Plan's Medical Management Plan....Medical Directors on case-specific issues. + Coordinates with Claims , Member Services, Grievance Coordinator and other operational departments… more
- CVS Health (Columbus, OH)
- …by the company) -3+ years of acute hospital clinical experience as an RN (general medical , post-surgical, ICU experience). **Preferred Qualifications** -1+ years ... with heart, each and every day. **Position Summary** This RN Case Manager role is 100% remote and the...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- CVS Health (Austin, TX)
- …we do it all with heart, each and every day. **Position Summary:** This Case Manager RN position is with Aetna's National Medical Excellence (NME) team and is a ... to apply, however, preference is for candidates in compact RN states. This role is a blended role doing...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- The County of Los Angeles (Los Angeles, CA)
- …be active and unrestricted. Successful candidates are required to provide proof of their Registered Nurse ( RN ) License and Basic Life Support (BLS) ... REGISTERED NURSE I/RELIEF NURSE ...vaccination against COVID-19 or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates… 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 ... then will go remote. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria...the state of hire, OR active compact multistate unrestricted RN license as defined by the Nurse … more