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Claims Review Nurse jobs

Viewing 1 - 10 of 18 jobs

  • Medical Reviewer - RN (HOPA)

    Oregon Employment Department - Portland, OR

    complicated post-service and pre-payment reviews *Conduct review activities with delegated entities as necessary and ... proactive approach to improve and standardize overall retro claims review for clinical perspectives *Identify potential...

    4 hours ago from Oregon Employment Department

  • RN/Reimbursement Analyst-Charge Capture, FT, M-F 8a-5p

    Tallahassee Memorial Healthcare - Tallahassee, FL

    established time frames * Analysis/oversight of audited claims pre-release to the applicable payer * Ensuring ... Utilization Review, Case Management, Payer Audits/Appeals) preferred, with knowledge of coding, billing, and reimburseme...

    30+ days ago from Tallahassee Memorial HealthCare

  • Case Manager - RN (HOPA)

    Oregon Employment Department - Portland, OR

    REQUIREMENTS: *Licensed Registered Nurse in the State of Oregon (will be required to provide license number) *Graduated ... of members in need of care coordination through reports, claims review, health risk assessments, pharmacology data,...

    4 hours ago from Oregon Employment Department

  • TEMPORARY RN: Care Manager II RN-Prior Auth (OR: Tigard) - 14004876

    Oregon Employment Department - Portland, OR

    Documents rate negotiation accurately for proper claims adjudication. * Coordinates UM/CM review activities ... Certification/License: - Active, valid, maintained & unrestricted state of Oregon Registered Nurse license required...

    4 hours ago from Oregon Employment Department

  • Director, Case Management

    El Paso Children's Hospital - El Paso, TX

    collaborates on course content, materials, and claims review. Identifies compliance and production problems and ... License/Registration/Certification Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners...

    30+ days ago from El Paso Children's Hospital

  • Registered Nurse Case Manager

    Oregon Employment Department - Roseburg, OR

    ESSENTIAL JOB RESPONSIBILITIES: *Review actual and proposed medical care and services compared to established ... member's care. *Approve or deny authorizations in our claims management system and create denial letters per OAR's...

    4 hours ago from Oregon Employment Department

  • Medical Scientist - Oncology Clinical Development

    Global Biopharmaceutical Company - Gaithersburg, MD

    CDP and ensuring linkage of trial data to target product claims / profile. * Input medical scientific information to ... for regulatory submission * Coordinate external consultant review of potential safety signals Education,...

    25 days ago from IvyExec

  • Medical Management Specialist - Position Closes 3/2/15

    Montana State Fund - Helena, MT

    team members in regards to medical claim management and Claims Best Practices. ESSENTIAL JOB FUNCTIONS - PERCENT OF ... Analyze medical claims management issues with other claims professionals through communication, coordination and...

    30+ days ago from Montana State Fund

  • Clinical Coordinator, Patient Financial Services (033)

    Indian River Medical Center - Vero Beach, FL

    Coordinates CareMedic process in Patient Access Area. Review and resolves ePremis Medical Necessity claims. ... At least 3 year UR/QA, Case Management and/or Claims Auditing experience preferred Proficient in ICD-9-CM, CPT and HCPCS...

    10 days ago from Indian River Medical Center

  • Medical Scientist, Early Clinical Development

    Global Biopharmaceutical Company - Boston, MA

    CDP and ensuring linkage of trial data to target product claims / profile. Input medical scientific information to ... Agile responsiveness to scientific data Embracing of peer review Agnostic to internal-external sourcing Preferred...

    30+ days ago from IvyExec

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