CLAIMS NURSE REVIEWER

Ready to help us transform healthcare? Bring your true colors to blue.The RoleThe Claims Nurse Reviewer is responsible for reviewing claims, validating coding and medical necessity of the services submitted and pricing the claims according to appropriate guidelines. This position requires strong clinical and medical coding skills to review claims for medical...

The Current Opportunity - Recovery, Tow & Storage SpecialistInnovative Claims Services, a progressive industry leader that provides comprehensive and tailored services for the insurance and transportation industries, is seeking a Recovery, Tow & Storage Specialist to work on behalf of our clients and support the logistics of towing and storing their assets...

Under the direction of the Nurse Director of the BWPO's South Shore Endoscopy Center (SSEC), the Registered Nurse GI Case Reviewer will work as a critical member of the procedural care team to support the quality, efficiency and satisfaction of care taking place at the SSEC. The incumbent is responsible for specific patient care duties aimed to ensure the...

Conduct in depth investigation to determine bond liability on construction bond claims. Reviewing all claims related documents, including proofs of loss and supporting documentation. Ensuring timely compliance with statutory and regulatory requirements. Collaborating with team members on claims files. Communicating effectively with principals, claimants and...

Utilization Review NursePer Diem 1648 Huntingdon Pike Nursing RN/LPN Day SUMMARY OF JOB: To review each admission for appropriate assignment of level of care based upon clinical guidelines as well as to review documentation for continued stays daily and provide clinical information including assessments and outcomes for all payers and all levels of care...

Building Name: HHH - In-State Hybrid/RemoteRegularDepartment: CVMC - Care ManagementFull TimeStandard Hours: 40Biweekly Scheduled Hours:Shift: DayPrimary Shift: 7:30 AM - 4:00 AMWeekend Needs: NoneRecruiter: Kate DaviesPOSITION SUMMARYThe Utilization Review Nurse is responsible for ensuring the medical necessity and appropriate level of care of all hospital...

Do you have experience as a medical claims examiner and looking for the next step in your career? Are you looking to work for a company that makes a difference in your community? APEX Placement and Consulting has partnered with a local company in Ossining, NY looking to add an experienced Senior Claims Examiner to their already amazing team! This...

Responsible for the review of precertification admission and concurrent reviews for the appropriateness of the inpatient setting utilizing InterQual criteria. Required to enter or reference data via PC, collaborate with facilities, providers and Medical Directors. Must have excellent written and oral communication skills. Other related skills may be required...

Per diem, 8a-4;30P as needed weekends + occ/ holidays About Us Milford Regional Medical Center is a full-service, community and regional teaching hospital located in Milford, Mass. and serves patients from more than 20 towns in Central Massachusetts. The 149-bed medical center is a nonprofit, acute-care facility, where more than 300 primary care and...

*This position involves:*· Follows adjudication policies and procedures to ensure proper payment of claims.· Resolves pending claims based on Medicaid rules and regulation established for final processing.· Resolves claims resolution and/or adjustments/voids.· Processes claim adjustments through Reversal/Replacement requests submitted by providers.·...

Job DescriptionJob DescriptionWe are looking for a Claims Business Analyst who will be the vital link between our information technology capacity and our business objectives by supporting and ensuring the successful completion of analytical, building, testing and deployment tasks of our software product’s features.This Claims Business Analyst works...

Description: Responsible for the review of post-acute precertification, admissions approvals, telephone triage, and/or benefit interpretation. May be required to enter or reference data via PC. Other related skills may be required to perform this job. The maximum hourly rate reflects budget estimates only and does not reflect the final negotiated rate. ...

This position is hybrid, allowing for remote work at times and requiring an onsite presence at Central Vermont Medical Center in Berlin, VT.POSITION SUMMARYThe Utilization Review Nurse is responsible for ensuring the medical necessity and appropriate level of care of all hospital admissions and extended hospital stays, including psychiatry; affirming...

This position is hybrid, allowing for remote work at times and requiring an onsite presence at Central Vermont Medical Center in Berlin, VT.POSITION SUMMARYThe Utilization Review Nurse is responsible for ensuring the medical necessity and appropriate level of care of all hospital admissions and extended hospital stays, including psychiatry; affirming...

 Job Description:· Participates in the development and ongoing implementation of QM Work Plan activities.· Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives  Responsibilities:· Reviews documentation and evaluates Potential Quality of Care issues based on clinical...

Under the direction of the Nurse Director of the BWPO's South Shore Endoscopy Center (SSEC), the Registered Nurse GI Case Reviewer will work as a critical member of the procedural care team to support the quality, efficiency and satisfaction of care taking place at the SSEC. The incumbent is responsible for specific patient care duties aimed to ensure the...

Department:Utilization ReviewShift:Primarily Days (United States of America)Employee Type:RegularPer Diem Type (if applicable):Minimum Pay Range:$55.77 - $69.71Job Description:POSITION SUMMARYThe Utilization Review Nurse (UR RN) uses a collaborative process, which provides professional accountability for the utilization of the health care resources to the...

Cranial Technologies is the only company in the world completely dedicated to the research, diagnosis and treatment of plagiocephaly, commonly called flat head syndrome. With over 300,000 babies successfully treated, we are the plagiocephaly experts.We are looking for a driven, detail-oriented Medical Claims Coordinator to join our rapidly growing team! As...

OverviewPerforms admission and continued stay utilization reviews and discharge screening to assure the medical necessity of hospital admission, appropriate level of care, continued stay and supportive services, and to examine delays in the provision of services. Coordinates care transitions from inpatient to the next level of care. Collaborates with...

Job Title: Registered Nurse Utilization ReviewLocation: Irving, TX, 75038Duration: 13 WeeksShift: Monday - Friday 8 am - 5 pmPay Rate: $30/hr. - $35/hr.Notes: Temp to Perm - Local Candidates only. Current RN Compact license requiredSummary: The RN Utilization Review II is responsible for determining the clinical appropriateness of care provided to...