Medical Claim Review Nurse Remote with MI RN License

For this position we are seeking a (RN) Registered Nurse with previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. COMPACT RN LICENSURE IS PREFERABLE to support multiple states. **WORK HOURS**: : 5 days / daytime work schedule 8:30AM to 5:30PM This department operates...

Job Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired...

Parameters of the provider's contract obligations. Audit claims processing quality, develops, maintains and runs standard reports. Assist the Claims Supervisor/ Director in reviewing the quality auditing tracking/reporting (financial and procedura Medical, Examiner, Claims, Claims Manager, Processing, Claims Supervisor, Healthcare, Staffing

This position will be a remote position. Must have a California SIP (Workers Compensation - Sr. Work Comp Claims Adjuster) Must be Bilingual (English/Spanish)POSITION SUMMARY: Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines. DUTIES AND RESPONSIBILITIES: ...

For this position it will be helpful to have previous experience in Acute Care, Concurrent Review/ Utilization Review / Utilization Management and prior knowledge of Interqual / MCG guidelines. Basic knowledge of Utilization Management processes desired. COMPACT LICENSURE IS REQUIRED to support multiple states. Further Details to be discussed during our...

**JOB DESCRIPTION** For this position we are seeking a (RN) Registered Nurse who must be licensed in the state they reside. The RN will provide prior authorization for outpatient services for the UT Medicaid population. Strong outpatient medical and hospital analytical experience is needed. Excellent computer multi-tasking skills and good productivity is...

Job DescriptionJob DescriptionThis position will be a remote position. Must have a California SIP (Workers Compensation - Sr. Work Comp Claims Adjuster)POSITION SUMMARY: Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.DUTIES AND RESPONSIBILITIES:Effectively...

Job Title: Workers Compensation Claims Examiner Contract: 6 months $45hr Location: Onsite preferred, Remote (within CA) or Hybrid consideredPRIMARY PURPOSE: Analyze mid- and higher-level workers' compensation claims to determine benefits due, ensure ongoing adjudication within company standards and industry best practices, and identify subrogation...

Job Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired...

**JOB DESCRIPTION** Care Review Clinician, Inpatient Review- Behavioral Health For this position we are seeking a LPC or LCSW who lives in and must be licensed for the state they reside. Strong inpatient medical and analytical experience is needed. Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role. Good...

PRIMARY PURPOSE: To supervise the operation of multiple teams of examiners and technical staff for workers compensation for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide technical/jurisdictional direction to examiner reports on claims adjudication; and to maintain a diary on claims in the...

Job Title: Claims Team Lead  Location: Los Angeles, CA Hybrid  Pay Range: $60hr  $60/Hr 6-Month Contract  PRIMARY PURPOSE: To supervise the operation of multiple teams of examiners and technical staff for workers' compensation for clients; to monitor colleagues' workloads, provide training, and monitor individual claim activities; to provide...

About RulaRula is a national behavioral health network that makes it easy for individuals, couples, and families to find the right provider covered by their health insurance. We are deeply committed to providing high-quality care that improves the lives of our clients, investing in the providers who deliver that care, and always operating in an ethical and...

**_Appeals & Grievances Health Claims Processing Specialist (REMOTE)_**Position Summary**: Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and providers (or authorized representatives) following the standards and requirements established by the Centers for Medicare and Medicaid. **Position...

PRIMARY PURPOSE: To provide support to the claims staff and to perform other office tasks as needs dictate for busy commercial auto claims office in Long Beach, NY. A hybrid work schedule is available. ESSENTIAL FUNCTIONS and RESPONSIBILITIES - Answers and initiates telephone calls and provide customer service as required - Index policies to determine if a...

Date Posted: 05/09/2024 Hiring Organization: Rose International Position Number: 463794 Job Title: Claims Examiner Job Location: Long Beach, CA, USA, 90806 Work Model: Hybrid Employment Type: Temporary Estimated Duration (In months): 8 Min Hourly Rate ($): 60.00 Max Hourly Rate ($): 60.00 Must Have Skills/Attributes: Claims, Document...

Workers Compensation Claims Examiner III Intro: TRISTAR Risk Management is seeking a seasoned Workers Compensation Claims Examiner III to manage all aspects of indemnity claims handling from inception to conclusion. This role is critical for the addition of staff to our new office and requires a professional with a strong background in workers' compensation...

Job DescriptionJOB DESCRIPTIONCare Review Clinician, Inpatient Review- Behavioral HealthFor this position we are seeking a LPC or LCSW who lives in and must be licensed for the state they reside. Strong inpatient medical and analytical experience is needed. Excellent computer multi-tasking skills and good productivity is essential for this fast-paced role....

Job Summary Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired...

**JOB DESCRIPTION** **Job Summary** Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients...