medical review nurse jobs

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Behavior Health Specialist
AP Staffing - 3 reviews - Boston, MA
Facilitate the coordination of behavioral health, medical management, and social case management and communicate with Associate Medical Director when necessary....
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HIM Clinical Coding Supervisor
AP Staffing - 3 reviews - Boston, MA
Conduct quality assurance activities and reviews for continuous education and development. Knowledge of medical terminology, anatomy and physiology,...
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LPN/LVN
Enlivant - Penn Hills, PA
Enlivant is seeking a Licensed Practical Nurse (LPN) / Licensed Vocational Nurse (LVN) at Allegheny Place. Clinical nurse, nursing, caretaker, quality assurance...
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Medical Claims Review RN - Nationwide Posting

UnitedHealth Group - 4,465 reviews - Shelton, CT
RN, Nurse, Preservice, Pre-Service, UM, UR, Clinical Review, Clinical Coverage, Utilization Management, Utilization Review, Case Manager, Case Management, LTC,...

UPIC Medical Review Nurse

Noridian Healthcare Solutions, LLC - McAllen, TX  +5 locations
Maintaining Medical Review (MR) Activities:. Review of Claims for Medical Necessity:. The UPIC Medical Review Nurse conducts medical record and claims review...

Documentation Specialist

South Shore Hospital - 78 reviews - South Weymouth, MA
This position is responsible for the concurrent review of the clinical documentation in the medical record and concurrent querying of medical staff caregivers...

Medical Claims Review Nurse

Care1st Health Plan Arizona - Phoenix, AZ 85016 (Camelback East area)
The Medical Claims Review Nurse performs comprehensive medical record and claims review on retrospective, prior period coverage, DRG and outlier claims to make...

PASRR Clinical Reviewer - Contractor

KePRO - United States
Change of status reviews:. Communicates with service providers, reviews available medical records, consults with family or other collateral sources, and...

Utilization Management Representative I-III - Norfolk, VA -...

Anthem, Inc. - 1,823 reviews - Norfolk, VA 23501  +4 locations
Refers cases requiring clinical review to a Nurse reviewer. Medical terminology training and experience in medical or insurance field preferred....

Medical Claims Review Nurse

Care1st Health Plan - 21 reviews - Arizona
The Medical Claims Review Nurse performs comprehensive medical record and claims review on retrospective, prior period coverage, DRG and outlier claims to make...

Nurse Reviewer

University of Massachusetts Medical School - 63 reviews - Shrewsbury, MA
Review Prior Authorization requests, as assigned, and make clinically appropriate decisions and medical necessity determinations to adjudicate these requests,...

Sr. Review Coordinator (RN - Behavioral Health)

Telligen - 17 reviews - Des Moines, IA
In addition, the incumbent may provide technical assistance, medical record review and support to provider staff and physician reviewers....

Medical Services Reviewer

Kaiser Permanente - 4,018 reviews - Aurora, CO
Reviews medical claims for appropriateness of care and medical necessity. Responsible for ensuring ongoing compliance for Medical Review....
Medical Review Nurse
Comprehensive Health Services - 66 reviews - Cape Canaveral, FL 32920
Performs medical review of incoming charts to determine if additional medical information is needed. Under general supervision, this position is responsible for...
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RN Medical Bill Auditor / UR Review
ManageAbility, Inc - Novi, MI
Able to effectively communicate with Medical Bill Review Analysts, other Co-workers, Claim Adjusters, Attorneys, Physicians and their staff.*....
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