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Claims Review Nurse jobs

Viewing 61 - 70 of 9,710 jobs

  • Utilization Review Nurse I

    Health Net - Rancho Cordova, CA

    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...

    30+ days ago from Health Net, Inc.

  • Utilization Review RN - Pharmacy

    Sedgwick Claims Management Services - Memphis, TN

    all utilization review outcomes in utilization review software. * Communicates and works with claim examiners ... Current unrestricted RN license required. Utilization review based certification strongly preferred. Experience Two...

    30+ days ago from Sedgwick Claims Management Services, Inc.

  • Clinical Review Auditor - RN

    Emdeon - Illinois

    as assigned. Medical necessity audits require a clinical review of physician documentation within inpatient medical ... desk or onsite Medical Necessity Audits as assigned. • Review inpatient medical records to determine if the ICD 9...

    10 hours ago from Emdeon

  • Utilization Review RN

    Dignity Health Medical Foundation Regional Affiliates - Rancho Cordova, CA

    Utilization Review RN JOB ID: 1400013853 LOCATION: Dignity Health MF Administration, Rancho Cordova, CA 95670 SHIFT: ... Regional Affiliates CATEGORY: Case Management / Utilization Review This position will review medical records, benefit,...

    15 hours ago from Dignity Health Medical Foundation Regional Affiliates

  • Nurse Reviewer (Fraud and Abuse)

    Hawaii News Now - Honolulu, HI

    3497Yes Company: Hawaii Medical Service Assn. Job Title: Nurse Reviewer (Fraud and Abuse) Exempt or Non-Exempt: ... in conducting a comprehensive evaluation and analysis of claims, initial submission and resubmitted. Conducts site...

    23 hours ago from Hawaii News Now

  • Registered Nurse Reviewer Needed

    Kelly Services - Indianapolis, IN

    Job Description: Medical Management/Review Registered Nurse 4+ MONTH CONTRACT EMPLOYMENT LOCATION: Indianapolis, INEvery ... review experience a plus. Pre certification and concurrent review experience a plus! Must have excellent communication...

    1 day ago from ZipRecruiter

  • Medical Review & Appeal RN

    Palmetto Health - Easley, SC

    RN is responsible and accountable for the evaluation of claims denials and of appeal activity for Baptist Easley ... documents. Performs medical documentation review and bill audits and resolves charge capture inquiries initiated...

    3 days ago from Palmetto Health

  • Nurse Reviewer

    Quality Health Strategies - Windsor Mill, MD

    professional position that performs medical record and claims review for Medicare, Medicaid, and/or other claims data ... Medicaid, and/or other claims. Duties include: Review Explanation of Benefit (EOB) cases, beneficiary,...

    7 days ago from Quality Health Strategies

  • SNF Concurrent Review Case Manager

    Essence Healthcare - Maryland Heights, MO

    Medicare program. Summary SNF concurrent review nurse, conducts the clinical review of skilled nursing facility ... Complete retrospective chart reviews and pended claims reviews as requested. Maintain strong collaborative working...

    12 days ago from Essence Healthcare

  • PRN RN, Targeted Review - 25-29 hours(298139)

    Kaiser Permanente - Atlanta, GA

    admissions. The activities will include telephonic review for medical necessity of the RN designated targeted ... • Refers the patient to the home care review team and/or social workers as appropriate...

    15 days ago from Kaiser Permanente

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