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Claims Review Nurse jobs

Viewing 1 - 10 of 1,373 jobs

  • UM Nurse Specialist

    ALR Partners - Los Angeles, CA

    for pre-service, concurrent post-service and retrospective claims medical review. Monitors and oversees the collection ... HMO - 3 years; ADDITIONAL INFORMATION Job Title: UM Nurse Specialist Job Category: Clinical / Non-Clinical...

    3 hours ago from ZipRecruiter

  • Utilization Review RN

    Judge Healthcare - Cleveland, OH

    Precertify/certify and concurrently review and manage all inpatient and observation admissions utilizing InterQual® Leve ... not limited to Emergency Department utilization/claims review. 3. Assess all members receiving inpatient or observation...

    6 days ago from ZipRecruiter

  • Utilization Review RN/LPN Coordinator

    Judge Healthcare - Cleveland, OH

    Precertify/certify and concurrently review and manage all inpatient and observation admissions utilizing InterQual® Leve ... not limited to Emergency Department utilization/claims review. 3. Assess all members receiving inpatient or observation...

    6 days ago from ZipRecruiter

  • RN - Care Coordinator

    Totalmed Staffing - Peoria, IL

    - Reviews health risk assessments, available claims information and member risk level to identify appropriate ... appropriate timeframes Job Requirements - Registered Nurse with active Illinois license - ADN or BSN degree eligible...

    22 days ago from ZipRecruiter

  • Utilization Management Coordinator- Acute Care RN

    Judge Healthcare - Maumee, OH

    Precertify/certify and concurrently review and manage all inpatient and observation admissions utilizing InterQual Utili ... not limited to Emergency Department utilization/claims review. Assess all members receiving inpatient or observation...

    6 days ago from ZipRecruiter

  • Special Projects Nurses

    Judge Healthcare - Miramar, FL

    Job Description: The role of an arbitrator is to review and analyze all OON claims assigned to them for billing/coding e ... via settlement of the OON claim received. All OON claims sent to the arbitrations team must be resolved within...

    24 days ago from ZipRecruiter

  • Utilization Review Nurse - Health Services Department Job

    Health Alliance Plan - Dearborn, MI

    General Summary: * Participate in all aspects of claims resolutions. * Assess claims for pended auths, ... claims. * Work with Coordination of Benefits staff to review all pended inpatient authorizations to obtain more...

    20 days ago from Health Alliance Plan

  • Utilization Review Nurse I - RN Temporary Positions Telecommuting from AZ, CA, OR or WA (US Citizenship Required) 10a-7p

    Health Net - Washington

    Utilization Review Nurse I provides first level clinical review for all outpatient and ancillary services requiring ... appropriate criteria, referring those requests that fail review to the medical director for second level review and...

    22 days ago from Health Net, Inc.

  • Temp Utilization Review Nurse

    Santa Clara Family Health Plan - Campbell, CA

    POSITION TITLE: Utilization Review Nurse DEPARTMENT: Utilization Management REPORTS TO: Utilization Management ... Review outpatient prior authorization requests and/or retrospective requests through claims review and incoming requests...

    30+ days ago from Santa Clara Family Health Plan

  • LPN Nurse Reviewer I Sens -- 99351

    AMERIGROUP - Harrisburg, PA

    that means more to you and those we serve. The LPN Nurse Reviewer I is responsible for working with healthcare ... is not associated with a continuum of care, radiology review, or other such review processes that require an...

    4 days ago from Amerigroup

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