- CVS Health (Phoenix, AZ)
- …remote work from home position and candidates from any state with a compact RN license can apply. **The hours are** **Monday - Friday** **8:00am-4:30pm in your time ... and experience with this is required. The Case Manager RN is responsible for telephonically and/or face to face...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- CVS Health (Phoenix, AZ)
- …remote work from home position and candidates from any state with a compact RN license can apply.** This position is for high-risk maternity case management team and ... experience with this is required. The Case Manager RN is responsible for telephonically and/or face to face...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- Banner Health (AZ)
- …and culture, arts and attractions, golf and original Southwest-inspired dining. The RN will be responsible for providing support to the Primary Care population ... in regards to Population Health goals and initiatives. The RN will assist with chart reviews, risk adjustment prep,...if we add additional Primary Care clinics.** Banner University Medical Group is our nonprofit faculty practice plan associated… more
- USAA (Phoenix, AZ)
- …to include 6 years of experience working as a Registered Nurse ( RN ), Nurse Practitioner (NP), or Medical Doctor (MD) with accountability for highly ... us special and impactful. **The Opportunity** USAA Life Company's Claim Team is seeking a talented ** Medical ...+ Expert Advice: Ability to review complicated medical records and medical claims ,… more
- Public Consulting Group (Phoenix, AZ)
- …sector. To learn more, visit www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case Manager ... Proven working experience in case management, including as a nurse , medical , mental health care manager or...plans. + Current license, certification or registration as a Registered Nurse or Social Worker **Working Conditions**… more
- Molina Healthcare (Phoenix, AZ)
- …to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. ... nursing experience with broad clinical knowledge. + Five years experience conducting medical review and coding/billing audits involving professional and facility… more
- Molina Healthcare (Tucson, AZ)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of… more
- Guardian Life (Phoenix, AZ)
- …providing comprehensive medical reviews and analysis of long-term disability claims . The RN Clinical Consultant identifies restrictions, limitations and ... duration impacting functional capacity based on medical data, to assist the Claim Managers...The RN Clinical Consultant reviews long-term disability claims to determine the impact of claimants' medical… more
- Sedgwick (Phoenix, AZ)
- …& Insurance RN Consultant Sr - Professional Liability **Prior Legal Nurse Consulting expereince highly preferred in order to be considered.** **PRIMARY PURPOSE** ... **:** To handle complex or high exposure claim issues; to provide medical knowledge of...Bachelor's degree from an accredited college or university preferred. RN license required. LNC (Legal Nurse Consultant)… more
- Sedgwick (Phoenix, AZ)
- …accredited college or university preferred. Current Certified Rehabilitation Counselor (CRC) or Registered Nurse ( RN ) license required. Current license, ... clinical evaluations on claims that require additional review based on medical condition, client requirement,... management of claims , including comprehension of medical terminology and substantiating claim decisions. **ADDITIONAL… more