Medical Claim Review Nurse jobs

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Clinical Risk Manager
Health Quest - 113 reviews - Poughkeepsie, NY 12601
Investigate incidents/adverse events to identify potential or actual claims and report them to the Claims Administrator....
No Fault Customer Claims Specialist
Liberty Mutual - 1,995 reviews - Uniondale, NY 11553
Manages, evaluates and resolves claims assigned by Claims Team Manager. Evaluates liability, medical necessity, causality and settles claims within prescribed...
Lead Clinical Review Nurse
Novitas Solutions, Inc. - Pittsburgh, PA 15206
O Assuring the accurate, efficient and timely payment determinations for both medical review and program management claim reviews....

Program Integrity Medical Review Manager

Integrity Management Services, Inc. - Remote
Both the Standard Medical Review Manager and the Program Integrity Medical Review Manager shall be a currently licensed registered nurse....
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TELECOMMUTE Quality Assurance Specialist (RN/LPN/LVN) 12:00p...

Dane Street - 11 reviews - United States
Estimated salary: $56,000 - $71,000 a year
Minimum of two years of experience in medical terminology, nursing, claims management, utilization review, pre-certification, medical administration or QA in a...
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Remote Quality Assurance Specialist, LPN or RN 10:00am-6:30p...

Dane Street - 11 reviews - Palm Beach Gardens, FL 33418
Estimated salary: $53,000 - $68,000 a year
Minimum of two years of experience in medical terminology, nursing, claims management, utilization review, pre-certification, medical administration or QA in a...
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Clinical Reviewer RN - Work At Home (Weekend Hours Required)

Cigna - 2,669 reviews - Nashville, TN
Estimated salary: $65,000 - $83,000 a year
Registered Nurse, Associate degree or higher. Review, research and understand how request for plan services and claims submitted by consumers (members) and...

Medical Review Nurse- Work At Home

Allegiance Benefit Plan Mgmt. - Montana
Other responsibilities will include performing retrospective review of high dollar claims, review claims that require medical knowledge evaluation of medical...
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Leads Claims Review Analyst

Incept Data Solutions, Inc - Work at Home
Estimated salary: $42,000 - $53,000 a year
Leads Claims Review Analyst (Work From Home)*. Recent Medicare Medical Review minimum 1 year of experience doing Home Health, Hospice or SNF review....
Easily apply

RN - Medical Case Manager

CorVel Corporation - 232 reviews - Des Moines, IA
Works closely with injured worker, Claims Adjusters, employers, and medical providers to ensure best possible medical care is received for the Worker...
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Medical Case Manager - Work From Home!

Broadspire - 98 reviews - DuBois, PA   +5 locations
A registered nurse (RN) license. May review files for claims adjusters and supervisors for appropriate referral for case management services....

Medical Specialist

Auto Club Group - 55 reviews - Dearborn, MI 48121
Works closely with claim representatives and serves as a resource for claims staff by providing medical direction on claims....

Utilization Management Representative I

Anthem, Inc. - 2,545 reviews - Mason, OH   +3 locations
Refers cases requiring clinical review to a Nurse reviewer. Medical terminology training and experience in medical or insurance field is preferred....
Utilization Review Coordinator, RN- Albany $5K Sign On Bonus
Visiting Nurse Association of Central New York Inc - Albany, NY
Performs continuing review of medical records and supporting documentation for medical necessity where appropriate....
Utilization Review Nurse - Part Time
Mercy - 272 reviews - Chesterfield, MO
Refers cases that do not meet medical criteria for precertification, inpatient concurrent review, and retrospective review to a Mercy Care Medical Director or...