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Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health and workers’ compensation claims.
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Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance and the development of policies that support these services.
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Knowledge of utilization management processes preferred. License/Certification:LPN - Licensed Practical Nurse - State Licensure requiredRN PreferredPay Range: $25.00 - $44.85 per hourCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
$25 - $44.85 an hourFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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As our Director of Specialty Bill Review Services, you will maximize savings and client satisfaction by providing strategic direction for Rising's Specialty Services unit involving complex/large medical claims; analyzing and optimizing bill review procedures and systems; and leading a team of experienced medical bill review auditors, nurse auditors, med-legal nurse, negotiators and related staff in an environment of continual performance improvement.
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This includes Itemized Bill Review, Clinical Chart Review, Dialysis Savings Solution and DRG Validation solutions. Position Overview At Zelis, the Business Analyst - Expert Claims Review (ECR) is ultimately responsible for enabling high quality user stories under our ECR product umbrella.
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Must have 2 years working in a hospital and 2 years of utilization review (UR) experience in a hospital or insurance company. Uses clinical and analytical skills to review and interpret diagnostic test results to determine appropriateness of patient's level of care.
$68,224 - $104,811.2 a year depends on experienceFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Leverage your understanding of the product development lifecycle and a threat actor mindset to conduct code review. You will apply your code review experience and contribute to a variety of services our team offers clients, particularly where we perform penetration testing across systems.
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Clinical Review Nurse I - Medicare Part B. Prior experience with claim review of Medicare helpful. The Clinical Nurse Reviewer I is responsible for reviewing and making medical determinations as to whether a claim meets the benefits the member carries.
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Results are achieved through data analytics, technology solutions, audit, investigation, and medical review. We are now seeking a Medical Review Manager to join our team. Certified Professional Coder (CPC) Certification or the ability to obtain this certification or similar coding certification within 12 months of appointment.
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Must have hands-on familiarity with a variety of computer applications, including word processing, databases (such as document review and file management systems), spreadsheets, and imaging. Obtains needed information from case files, law enforcement agencies, civil client agencies, or other sources, and submits completed legal documents to the appropriate client assistant attorney for review and approval.
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Eight years of wholesale or retail banking credit experience in one or more of the following functions: credit analyst, underwriter, portfolio manager, relationship manager, credit risk review officer, or credit approval officer.
$116,280 - $150,480 a yearFull-timeExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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RN – Case Manager
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Preferred Experience: Care Management or Utilization Review experience, Preferred. Mery South - de Greeff Hospice House & Field Hospice - Registered Nurse - Utilization Review.
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This is a non-supervisory role, reporting to the QA Supervisor Batch Record Review and Release at the Thermo Fisher St. Louis site. Job Title: Lead QA Technician – Batch Record Review and Release (Quality Associate 4.
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JOB SUMMARYThe RN Utilization Review coordinates care for OPIS patients who are high cost, complex, and at risk. · Review medical records for knowledge/understanding of situation and resource assessment.
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Title: utilization review Company: Corvel in St Louis, MO
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