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Relying on clinical background, reviews health claims providing medical interpretation and decisions about the appropriateness of services...
The essential functions, duties, and responsibilities include, but are not limited to the following:
* Data entry, annotation and review of documentation...
This position monitors and controls the workflow of legal claims, maintains legal files and acts as a liaison between internal departments, CHRISTUS...
* Work closely with executive leadership and the EHS team to ensure safety is the number one priority for the company and the safety program is consistently...
As a Behavioral Health Claims Review RN you will…
* This project is specifically aligned with AZ Medicaid-AHCCCS and CMS.
* Issues were noticed last...
* Work closely with executive leadership and the EHS team to ensure safety is the number one priority for the company and the safety program is consistently...
* Determine eligibility and process benefit estimates, retirement calculations, and death benefit claims.
* Research and respond to service...
Manage a portfolio of active claims and the contractors working those assignments.
Monitor assignments aging, statuses, and work product.
Daily...
BA/BS in nursing degree and current RN license in New York State
• Prefer minimum of 1-3 years relevant experience in case management, utilization...
As a Behavioral Health Claims Review RN you will…
* This project is specifically aligned with AZ Medicaid-AHCCCS and CMS.
* Issues were noticed last...
* Work closely with executive leadership and the EHS team to ensure safety is the number one priority for the company and the safety program is consistently...
BA/BS in nursing degree and current RN license in New York State
• Prefer minimum of 1-3 years relevant experience in case management, utilization...
* Determine eligibility and process benefit estimates, retirement calculations, and death benefit claims.
* Research and respond to service...
Manage a portfolio of active claims and the contractors working those assignments.
Monitor assignments aging, statuses, and work product.
Daily...
As a Behavioral Health Claims Review RN you will…
* This project is specifically aligned with AZ Medicaid-AHCCCS and CMS.
* Issues were noticed last...
* Utilize the Preferred One medical criteria and those of other regulatory bodies, (i.e. NCQA, DOH), the exempt and focused review programs, and...
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our...
* Perform comprehensive inpatient DRG validation reviews to determine accuracy of the DRG billed, based on industry standard coding guidelines...
The RN will utilize standard criteria to review post-service and prepayment reviews of OP Behavioral Health claims. The nurse will utilize HCPC...
The successful candidate will also serve as a member of the Promotional Review Board (PRB). This role is ideal for someone with a background in healthcare...
