- Molina Healthcare (NE)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring ... Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have...nursing experience, including at least 1 year of utilization review , medical claims review , long-term… more
- Zurich NA (Schaumburg, IL)
- Medical Bill Review Senior Nurse 127127 Zurich Insurance is currently looking for a ** Medical Bill Review Senior Nurse ** to work from our ... quickly and completely, provide status updates to ensure customer satisfaction. + Review assigned medical bills, apply technical insights, applying discretion… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …recent LPN experience providing direct patient care with one year of authorization, medical review experience and case management is required **Skills and ... required within 24 months in position. + A comparable professional medical review or case management certification is preferred **ACCOUNTABILITIES AND ESSENTIAL… more
- The County of Los Angeles (Los Angeles, CA)
- …REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse * or Medical Service Coordinator, CCS.** -OR- OPTION ... UTILIZATION REVIEW NURSE SUPERVISOR I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333)...needed, and to make recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review… more
- UCLA Health (Los Angeles, CA)
- …for reviewing and evaluating clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical ... Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role...protocols and national clinical guidelines (eg, InterQual, Milliman) in review decisions. + Coordinates escalations to medical … more
- CVS Health (Lansing, MI)
- …lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review , you'll play a vital ... skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and… more
- Elevance Health (Houston, TX)
- …states; therefore, Multi-State Licensure will be required.** The ** Medical Management Nurse ** is responsible for review of the most complex or challenging ... ** Medical Management Nurse ** **Location: Virtual: This...Skills and Experiences:** + ACMP experience is preferred. + Medical Management experience is preferred, + Utilization Review… more
- HCA Healthcare (Nashville, TN)
- …growth, we encourage you to apply for our Trauma Medical Surgical Nurse opening. We promptly review all applications. Highly qualified candidates will be ... candidates!** Introduction Do you have the career opportunities as a(an) Trauma Medical Surgical Nurse you want with your current employer? We have an exciting… more
- HCA Healthcare (Manchester, NH)
- …encourage you to apply for our PRN Cardiac Medical Surgical Registered Nurse opening. We review all applications. Qualified candidates will be contacted for ... **F200** Introduction Do you have the PRN career opportunities as a(an) PRN Cardiac Medical Surgical Registered Nurse you want with your current employer? We… more
- HCA Healthcare (San Antonio, TX)
- …career path, we encourage you to apply for our Medical ICU Registered Nurse opening. We review all applications. Qualified candidates will be contacted by a ... **Description** **Introduction** Do you have the career opportunities as a Medical ICU Registered Nurse you want in your current role? We invest in what matters… more