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Benefit Review Rn Jobs

Concurrent Review Nurse, Rn - 23-246
By Hill Physicians Medical Group At , Sacramento

We’re delighted you’re considering joining us!

Prn-Ur Clinical Review Rn - Support Center (Remote)
By Children's Healthcare of Atlanta At , Brookhaven, 30329

Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs). Work Shift Day ...

Benefit Review Rn - Remote | Wfh
By Get It Recruit - Healthcare At Philadelphia, PA, United States

Join our dynamic team and embark on an exciting journey in the world of healthcare management! We are seeking a passionate and dedicated individual to fill the role of Clinical Benefit Review ...

Care Review Clinician, Inpatient Review (Rn) - Mississippi
By Molina Healthcare At , Starkville, Ms $26.41 - $51.49 an hour

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

To all current Molina employees:

Medical Review Rn -Experienced - Home Or Office Based
By Qlarant At Dallas, TX, United States
Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
ICD-9 coding, CPT coding, and knowledge of Medicare and/or Medicaid regulations preferred. CPC or similar certification preferred.
Completes desk review or field audits to meet applicable contract requirements and to identify evidence of potential overpayment or fraud.
Consults with Benefit Integrity investigation experts and pharmacists for advice and clarification.
Responsible for case specific or plan specific data entry and reporting.
Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data.
Benefit Review Rn Jobs
By Imagine360 At United States
Superior time management and multi-tasking skills
Staffs medically complex cases with the Supervisor of Case Management, designee, or Medical Director as directed.
Provides requested diagnosis/prognosis reports and stop loss reports that are received via Medical Management department requests.
Reviews high dollar pharmacy reports to identify appropriate referrals to Case Management or other Medical Management Services.
Assess and review current treatment history to identify appropriate referrals to Case Management Program or other Medical Management Services.
Consistently follows department Benefit Review policies and procedures to complete the review processes.