Claims Review Management Nurse
HealthSkil
Job Description
Job Description
Provide Utilization Review experience, managerial leadership and oversight. Requires active Pennsylvania nursing license, using criteria sets and a history of five years experience in the review process. Must have a strong knowledge of coding and claims review experience as well as strong computer skills, particularly in Microsoft Office.
Will be assigned to a Medicare work group and project team, consisting of on-going process responsibilities and work group participation. Consult with senior staff to outline and improve major operational issues. Act as a liason between departments. Help develop in-house training materials and programs relating to claims review processing. Assist in determining necessary changes relating to criteria or regulations to better serve clients. Interface with Providers with billing and claims issues. Positions in Harrisburg, Philadelphia, and Pittsburgh.
\nCompany DescriptionPleasant office environment. The CK Hobbie Group is a fifty-six year old recruiting and staffing business
Company Description
Pleasant office environment. The CK Hobbie Group is a fifty-six year old recruiting and staffing business
- ...Claims Review Management Nurse (RN) We are seeking an experienced Claims Review Management Nurse (RN) to support the Pennsylvania Medicaid program in a long-term, full-time contract role based in Harrisburg, PA, with a hybrid schedule (three days remote, two days onsite...ClaimsLong term contractFull timeContract workWork at officeRemote work2 days per week
- ...Description Are you a registered nurse ready to take your career in an exciting... ...program integrity through compliance management. Here, you'll champion the needs of... ...ofthe traditional bedside setting to review and audit claims, supportprogram integrity initiatives,...ClaimsFull timeTemporary workWork at officeRemote workWork from home
$78.4k - $107.8k
...our caring community The Nurse Auditor 2 performs clinical audit... ...follow-up care by disease management, case management, and primary... ...coding experience to conduct reviews of provider codes and billing... ...CIS, CIC) ~Inpatient coding claim experience ~ Prospective...ClaimsBi-weekly payFull timeTemporary workApprenticeshipRemote workWork from homeHome officeMonday to Friday$54.1k - $155.54k
...Holding, Inc (AHH) is a medical management company that is a division... ...multidisciplinary focus to benefit overall claim management. Using a... ...Perform medical necessity reviews. Required Qualifications... ...' experience as a Registered Nurse with at least 1 year of...ClaimsHourly payFull timeLocal areaRemote workWork from homeFlexible hours$60.52k - $129.62k
...community at a time. This RN Case Manager position is 100% remote and... ...hours. There is a preference for nurses in a compact RN licensure state, however... ...clinical tools and information/data review (e.g., assessments, claims, etc.) conducts an evaluation of member...ClaimsHourly payFull timeTemporary workWork at officeLocal areaRemote workWork from homeMonday to FridayShift workWeekend work$93.89k - $111.96k
...THE POSITION The Registered Nurse at South Mountain Restoration Center helps... ...letters, and similar documents will not be reviewed, and the information contained therein will... ...detailed experience/education). If you are claiming education in your answers to the...ClaimsPermanent employmentFull timeTemporary workWork at officeLocal areaRemote workWork from homeFlexible hoursNight shiftDay shiftAfternoon shift- ...the administration of the site Quality Management System of the Food Service operation in... ...preparation of the facilities for such audits.Review and coordinate all site-specific... ...response to customer quality complaints and claims.Maintain corrective and preventive action...ClaimsWork at office
$160k
...Pennsylvania (CCAP) is seeking an accomplished executive to serve as Managing Director of Insurance Programs, leading one of the Association'... ...provide insurance, risk management, loss prevention, and claims support designed specifically for county government. The next Managing...ClaimsWork at officeFlexible hours- ...opportunity for a Personal Lines Account Manager in our Harrisburg, PA office. In... ...processing applications, policy changes, account review and renewal remarkets, up-selling... ...of insurance, and binders. Process claim reports according to carrier procedures or...ClaimsWork at officeLocal area
$173.08k - $276.47k
...scheduling, estimating, cost control, risk management, document control and project management... ...controls activities.Participates in the review and assessment of the project team or... ...team or client/owner related to potential claims, claims avoidance, and claims support....ClaimsFull timeContract workFor contractors- ...Winter 2026. Applications are actively being reviewed and interviews are being scheduled.... ...days Responsibilities Operations Managers develop methods and procedures for the... ...i.e. line haul, sales, maintenance and claims. Issue directives to subordinates to...ClaimsWeekly payWork at officeShift work
$18 - $20 per hour
...Workplaces in Financial Services & Insurance Utilization Review Coordinator PRIMARY PURPOSE : To assign utilization... ...necessary. Enters demographics and UR information into claims or clinical management system; maintains data integrity. Obtains all necessary...ClaimsWork at officeLocal areaFlexible hours$111.3k - $215.1k
...as we are, join our team.KPMG is currently seeking a Manager, ECC Contracts to join our Enterprise Contracting Center... ...and information gathering for quarterly business reviews, internal audits, and client claims; recommend and execute process enhancements and improvements...ClaimsContract workH1bWork at officeLocal area$198k
Commercial Account Manager IVThis role has been designated as ‘Remote/Teleworker’, which... ...manages planning process through scheduled reviews and updates.Extensive time working with... ...the credentials of any third party claiming to represent the company. Any reliance on...ClaimsFull timeWork experience placementWork at officeLocal areaImmediate startRemote workWork from home$41.51k - $61.93k
...23520 Bureau / Division L&I BAS Management Services Division Worksite Address... ...to complete assigned print jobs File Review: Examine failed processes to identify incorrect... ...experience/education). If you are claiming education in your answers to the...ClaimsPermanent employmentFull timeWork at officeLocal areaRemote workMonday to Friday$263k
Senior Manager, Channel Security Sales - North AmericaThis role has been designated as ‘... ...securing everything.Lead executive business reviews and customer engagement strategies.Sales... ...the credentials of any third party claiming to represent the company. Any reliance on...ClaimsFull timeWork experience placementLocal areaImmediate startRemote workWork from home- ...RK&K is seeking an Assistant Construction Manager to join our Construction Engineering and... ...federal and state agencies, and citizens Review and understand the project plans,... ...controls (CPM scheduling, cost estimating, claim analysis) Preferred Skills and Experience...ClaimsContract workFor contractorsWork at officeLocal area
$91.5k - $139.09k
...Bureau / Division: Bureau of Fiscal Review Worksite Address: 613 North Street... ...Review is seeking a dedicated Senior Audit Manager to oversee our audit team and ensure the... ...must include a resume . If you are claiming education in your answers to the supplemental...ClaimsPermanent employmentFull timeWork experience placementWork at officeLocal areaRemote workWork from homeMonday to FridayFlexible hours$41.51k - $61.93k
...Division: Bureau of Registration and Taxpayer Management, Taxpayer Registration Division, Tax... ...duties: Account Updates: Review and update customer account details to support... ...experience/education). If you are claiming education in your answers to the supplemental...ClaimsPermanent employmentFull timePart timeWork experience placementWork at officeLocal areaRemote workWork from homeMonday to FridayFlexible hours3 days per week$223.8k - $313.1k
...community The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately... ...-based cases and deliver clear, well-reasoned utilization management determinations. Communicate with external providers via...ClaimsFull timeTemporary workApprenticeshipWork at officeLocal areaRemote workWork from homeHome officeMonday to FridayWeekend work$120k
...Overview Contracts Manager (CONT-2026-26334): Bowhead seeks a Contracts Manager who will be responsible for the review, negotiation, and management of large, complex, multifaceted... ...EOE/D/V. Pursuant to The Alaska Native Claims Settlement Act 43 U.S.C. Sec. 1601 et...ClaimsFull timeContract workTemporary workPart timeFor contractorsWork experience placementWork at officeRemote work$60k - $72k
...with the Service Administrator & Service Manager Effectively prioritize service... ...services, preventative maintenance, warranty claims, and equipment startups Coordinate the... ...manage work orders in SharePoint/Egnyte Reviewing and finalizing technician field repair...ClaimsFull timeTemporary workWork at officeDay shift- ...with a great team! MPB Insurance & Risk Management, a subsidiary of Mid Penn Bancorp, Inc.... ...through proactive communication and policy reviews and assists in growing the book of... ...COBRA administration, billing issues, and claims assistance. Educates and guides clients...ClaimsWork experience placementWork at officeWork visaFlexible hours
$60.54k - $92.01k
...6-60239-76198 Department: Emergency Management Agency Division: EM Nclr Powr Plnts... ...radiological emergency preparedness by reviewing plans, coordinating training, and guiding... ...detailed experience/education). If you are claiming education in your answers to the...ClaimsPermanent employmentFull timePart timeTraineeshipWork experience placementWork at officeLocal areaRemote workWork from homeMonday to FridayFlexible hoursShift workNight shift- ...about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you’ll play a... ...issues early. Leads group meetings across audiences (e.g., claim reviews, stewardship meetings, and partnership meetings) with modest...ClaimsLocal areaRemote work
$18 - $22 per hour
...background who enjoys solving billing issues, working with insurance claims, and being part of a small, supportive team. What You’ll Do... ...appeals Generate secondary claims and patient statements Review billing information for accuracy Work with CPT/procedure and...ClaimsFull timeCasual workWork at officeMonday to Friday$128.11k
...Source is seeking an Examiner Nurse Practitioner to conduct... ...This role focuses on reviewing medical records, performing focused... ...planning, or ongoing patient management. Pay Rate: $128,110/... ...physical assessments related to claimed conditions. Prepare objective...ClaimsFor contractorsFor subcontractorWorldwideMonday to FridayWeekday work$52k
...eligibility, coverages, policy changes, transfers, claim submissions, and billing clarification.Use a customer-focused, needs-based review process to educate customers about... ...About Our AgencyOur mission is to help people manage the risks of everyday life, recover from...ClaimsFor contractorsWork at office$128.11k
...). This role focuses on reviewing medical records, performing focused... ...planning, or ongoing patient management. Pay Rate: $128,110.40... ...assessments related to claimed conditions. · Prepare objective... ...· Graduate of a professional nursing program accredited by an...ClaimsFor contractorsFor subcontractorWorldwideMonday to FridayWeekday work$18 per hour
...overpayments on true-up invoices. Independently reviews and interprets sold documentation and... ...tasks. Prepares monthly updates for management reports. Maintains appropriate file... ...Expert knowledge of insurance programs, claims and implications to outstanding...ClaimsPart timeWork at officeLocal areaShift work
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