- Evolent (Lincoln, NE)
- …scheduled. + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks… more
- Molina Healthcare (Grand Island, NE)
- JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring timely ... Friday 8:00am - 5:00pm. **Essential Job Duties** * Performs clinical / medical reviews of retrospective medical ...hospital setting, including at least 1 year of utilization review , medical claims review , claims… more
- Molina Healthcare (Lincoln, NE)
- …for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, responsible for ... Payment Integrity analytical team; requires decision making pertinent to clinical experience + Documents clinical review...clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review .… more
- Cognizant (Lincoln, NE)
- …necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited...thinking skills to interpret guidelines of internal policies for clinical determination. . Medical Necessity Reviews can… more
- Fresenius Medical Center (Grand Island, NE)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
- St Croix Hospice (Norfolk, NE)
- … Nurse The Nurse Practitioner is a registered professional nurse with advanced graduate education and clinical training who provides comprehensive ... Nurse Practitioner (NP) Job Details Level Experienced Job...conditions of participation and the local coverage determinations. Provides clinical information to the hospice medical director… more
- Veterans Affairs, Veterans Health Administration (North Platte, NE)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Whole Health System of care in each of the Medical Centers. This is an approach to healthcare that...that improves their health and well-being. The Advanced Practice Nurse (APN) III Certified Nurse Practitioner (NP)… more
- Veterans Affairs, Veterans Health Administration (Omaha, NE)
- …preceptor providing didactic and clinical instruction in anesthesia to student nurse anesthetists, medical and dental residents, and other health care ... VA NWIHCS is hiring one, full time Certified Registered Nurse Anesthetist. VA NWIHCS is an integrated system that...western Iowa, Kansas, and Missouri. It includes a tertiary medical center in Omaha, 2 larger clinics in Lincoln… more
- Veterans Affairs, Veterans Health Administration (Grand Island, NE)
- …development through orientation, ongoing training, and skill-building to strengthen clinical excellence. Contribute to quality improvement projects that enhance ... care in the CLC. VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases, potential for performance… more
- CVS Health (Lincoln, NE)
- …benefit overall claim management. + Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to ... in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993,… more