- Molina Healthcare (Albuquerque, NM)
- JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring ... hospital setting, including at least 1 year of utilization review , medical claims review...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Buffalo, NY)
- …work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and ... Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in … more
- Molina Healthcare (Long Beach, CA)
- …clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review . **Required License, Certification, Association** Active, ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...Nurse (LVN) license in good standing. **Preferred Education** Registered Nurse . Bachelor's Degree in Nursing or… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …18 month commitment before posting for other internal positions\. **Job Qualifications** _License_ + Registered Nurse \( RN \) with active license in the state ... Performing comprehensive provider and member appeals, denial interpretation for letters, retrospective claim review , special review requests, and UM… more
- Zelis (St. Petersburg, FL)
- …in an advisory role with management of direct reports required. + Advanced competency in medical claim review and payment integrity preferred. + Ability to ... a team of Clinician's performing clinical reviews of facility claims , including UB's, Itemized Bills and medical ...consistently. + Assess, track and report any delays in claim review or processing to the Manager,… more
- Centene Corporation (New York, NY)
- … Licensure as well as a State Issued NY ID.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all outpatient ... beneficiary and the Network Provider. + Provides first level RN review for all outpatient and ancillary...necessity using appropriate criteria, referring those requests that fail review to the medical director for second… 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
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical ... protocol sets, or clinical guidelines and provide support and review of medical claims and...customer service skills required. **Minimum License Requirement :** California RN license. Delivering world-class health care one patient at… more
- Geisinger (Danville, PA)
- …and Jersey Shore. Some remote work hours are available. At least 5 years of Registered Nurse work experience and a BSN is required. The ideal candidate will ... Experience Minimum of 5 years-Nursing (Required) Certification(s) and License(s) Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania OUR PURPOSE… 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
Recent Jobs
-
Certified Medical Assistant Population Health Specialist
- Banner Health (Tucson, AZ)
-
Part-Time Lecturer Pool - Department of Anthropology
- University of Miami (Coral Gables, FL)
-
Engagement and Events Manager, Harpur College
- Binghamton University (Binghamton, NY)
-
HSE - Natural Gas Specialist
- Rolfson Oil (Odessa, TX)