Remote LVN Claims Reviewer: Care & Compliance
Inland-Empire-Health-Plan-
- Remote job
Inland Empire Health Plan is seeking a Claims Review Nurse, LVN to perform timely medical reviews of facility and professional claims. You will identify improvements in the UM/Claims interface and support clinical determinations under supervision, helping IEHP meet quality goals. The role requires an active CA LVN license and at least one year of related experience in utilization, case management or claims auditing. Telecommute option may apply in this role. #J-18808-Ljbffr Inland-Empire-Health-Plan-
- ...mandated turnaround times. Our reviewers are compensated on a per-case... ...and retrospective claims. The physician reviewer will... ...healthcare professionals in compliance with client-specific policies... ...guidelines, and standards of care. Major Duties and Responsibilities...Remote workClaimsFor contractors
- ...workers' compensation, liability, managed care, and risk management across 32 states.... ...Intercare, InterMed, George Hills, and AS&G Claims Administration, we're a people-focused,... ...clarify information. Forwards to Bill Review supervisor any unidentifiable unlisted procedure...Remote workClaims16 hoursFull timeShift work
- ...Hmong Chinese Language Document Reviewer Employment Type: Full Time, Mid-Level Department... ..., rules to show cause, proofs of claim, motions for summary judgment, dismissals... ...those relations for years to come. We care about our employees. Therefore, we offer...Remote workClaimsFull timeWork at officeFlexible hours
- Vytwo seeks a Physician ED Claims Reviewer for a 12-month remote assignment. The clinician will conduct clinical review of claims and UM authorization... ...clinical necessity, leveraging CPT/HCPCS coding and managed care expertise. Ideal candidates hold an active US medical...Remote jobClaims
$17.94 per hour
This is a remote position, but successful candidates must reside... ...Patent Application Specialist (Reviewer) to support patent... ...conversion and composition to ensure compliance with quality standards and rules... ...and titles, adjustments to claim indentation). Report onsite...Remote workClaimsHourly payContract workWork at office- Inland Empire Health Plan in California seeks an LVN-validated Claims Review Nurse to audit medical necessity across inpatient and outpatient claims... ...with physicians and staff to improve denial management and care pathways. The role requires an active California LVN...Remote jobClaims
$79.56k - $115.72k
...for-profit, we support patient care, research, teaching, and... ...more. The Supervisor, Medicaid Claims Review is responsible for leading a... ...Medicaid claims for accuracy, compliance, and eligibility, ensuring that... ...position is eligible for remote work from approved U.S. locations...Remote workClaimsFull timeWork at officeMonday to FridayFlexible hoursShift work- ...Registered Nurse: Review and EvaluationAre you a registered nurse... ...and program integrity through compliance management. Here, you'll champion... ..., safeguard the quality of care, and influence healthcare outcomes... ...setting to review and audit claims, support program integrity initiatives...Remote workClaimsWork from home
- ...high-touch support for medical, claims, and coverage concerns. Acting... ...members receive appropriate care, understand their benefits, and... .... Documentation and Compliance Accurately document all interactions... ...8204 (Hybrid Work Options) ~ Remote work opportunities available...Remote workClaimsFull timeWork at officeMonday to Friday
$91.7k - $163.7k
...global organization that delivers care, aided by technology to help... ...together. Psychologist Peer Reviewer is for an Outpatient Public Sector... ...have the flexibility to work remotely* as you take on some tough... ...acquire authorizations, file claims, conduct peer reviews, etc. Advanced...Remote jobClaimsMinimum wagePermanent employmentFull timeWork experience placementInternshipWork at officeLocal areaWork from homeMonday to Friday$70k
Coding and OASIS Reviewer- Full Time/Remote Position Healthcare Provider Solutions is a growing healthcare... ...and clinical consulting to the home care and hospice industries. Healthcare... ...collection projects, clinical compliance chart reviews, operational reviews, managed...Remote jobFull timeWork at officeLocal areaImmediate startMonday to FridayFlexible hoursShift workDay shift$68.64k - $72.8k
...Opportunity Overview: The RN Reviewer position is a crucial... ...cost-effective care by applying your clinical... ...guidelines to ensure compliance and consistency Partner... ...skills across remote teams Customer-focused... ...data with post-service claims validation, we’re creating...Remote workClaimsHourly payFull timeFlexible hoursShift workWeekend work- ...billing operations in a remote healthcare environment.... ...documentation, timely claims processing, and reliable... ...while maintaining compliance with payer requirements... ...Medicaid, and managed care organizations. Manage... ...and signatures. Review, prepare, and submit medical...Remote workClaimsWeekly payDaily paidFull timeMonday to Friday
- ...TitleResponsibilitiesPrepare and submit accurate claims to Medicare, Medicaid,... ...coverage and ensure compliance with Medicare and... ...manner.Generate and review monthly billing reports... ...Makes Us UniqueAt Med-Care Providers, we are more... .... Some flexibility in remote or hybrid work...Remote workClaims
- ...Supporting the pricing function for value-based care partnerships, the full-time remote Actuarial Associate will manage underwriting analytics, partner... ...SQL queries to pull, join, and manipulate partner claims, eligibility, and revenue data Build and maintain Excel...Remote workClaimsFull time
- ...Licensed Vocational Nurse (LVN) The Licensed Vocational Nurse... ...LVN supports quality patient care, clinical operations, and Quality... ...Medical Department, ensures compliance with clinic policies and procedures... ...to qualified applicants claiming Veteran's Preference who have...ClaimsLocal area
$24 - $28 per hour
...Partners, exceptional patient care starts with the behind-the-scenes... ...Management team to resolve claims issues. Organization, adaptability... ...and Friday 8:00am - 5:00pm remote Pay: $24 - $28/hour... ...ensure timely submissions Review and update payer rosters for accuracy...Remote workClaimsContract workWork at office$77.1k - $92.52k
...10041 Category: Compliance Agency: Elderplan... ...Full-Time Office: Remote Salary: $77... ...Medicare and Medicaid managed care health plans, are... ...investigator analyzes claims, encounter, enrollment,... ...required. Knowledge of reviewing medical records/...Remote workClaimsFull timePart timeWork at officeFlexible hours$120k - $170k
...capabilities as it brings additional Value-Based Care analytics and financial performance work... ...experience working with healthcare claims and membership/eligibility dataExperience... ...actuarial team.The position is fully remote across the US.For further details or a confidential...Remote workClaims$18 - $26 per hour
...Place, Complete Counseling Care, our work is guided by... ...processing insurance claims, managing credentialing... ...records in compliance with applicable laws and... ...and in a timely manner Review and resolve claim denials... ...approximately 15-20 hours per week Remote-first / hybrid position...Remote workClaimsHourly payFull timeTemporary workPart timeWork experience placementWork at office$68.89k - $92.14k
...Pay Plan Title: Compliance Nurse Working Title: Compliance Nurse... ...92,138 Office Location: Remote within North Carolina... ...Tailored Plan and Managed Care Organization (MCO) serving... ...performs clinical compliance reviews and evaluates claims to ensure adherence to regulatory...Remote workClaimsWork at officeLocal areaImmediate startWork from homeFlexible hours$205k - $375k
...Flexible Hybrid Schedule | Fully Remote workableMust be CA or D.C.... ...physician organizations, managed care entities, and other healthcare... ...and advise clients on compliance and riskParticipate in administrative... ...investigationsFalse Claims Act mattersFraud and abuse enforcementHealthcare...Remote workClaimsFlexible hours- ...expert guide. We work hard, care deeply and reach... ...physicians, coders, failed claims specialists, and... ...documentation, and coding compliance. The analyst also collaborates... ...and Operations staff. Reviews MediRegs, research of... ...of employment Remote Work Disclaimer: Positions...Remote workClaimsLocal areaShift work
$49.92k - $54.08k
...Remote Patient Monitoring - LVN/LPN Clinical | Remote Employment Type... ...is transforming how care is delivered through... ...comprehensive chart reviews Accurately... ...departmental goals Maintain compliance with company... ...message, or job offer claiming to be from Nsight Health...Remote workClaimsHourly payFull timeWork from homeRelocation packageMonday to FridayShift workNight shiftWeekend workAfternoon shift$63.9k - $83.08k
...to pivot from a “job” opportunity to an authentic experience! Reporting to the Supervisor, Integrated Transitional Care, the Claims Review Nurse, LVN is responsible for conducting timely medical reviews of IEHP facility and professional claims and appeals. The Claims...Remote jobClaimsTemporary workWork experience placementFlexible hours$25 - $35 per hour
...organization for a contract remote opportunity located in... ...the appeals team, reviewing complex cases, ensuring regulatory compliance, and supporting accurate... ...coordinating necessary claim adjustments. • Identify... ...healthcare compliance, managed care, appeals processing,...Remote workClaimsHourly payContract work$3,000 - $8,000 per month
...our community with integrity, care, and real support. Whether we'... ...helping someone navigate filing a claim or personalize a plan, we... ...established objectives. Maintain compliance with office and regulatory... ...licenses. This is a remote position. Compensation: $3,...Remote workClaimsWork at office$25 - $28 per hour
...Sr. Compliance Specialist FreedomCare is a healthcare company that... ...to revolutionizing the home care industry since 2016. We support... ...the compliance department in reviewing legal documents, conducting,... ...investigating Fraud, Waste & Abuse claims. The Compliance Specialist...Remote workClaims- ...Description The utilization review and management (UM)... ...the appropriate level of care, while supporting regulatory compliance and organizational risk management... ...and documentation of claims along the process chain.... ...This is an in-office, no remote work capability position...Remote workClaimsWork at office
$75k - $125k
...learn and grow, and genuinely care about the people they work with... ...case strategy and ensure compliance with Florida law. Draft clear... ...beneficiaries, fiduciaries, and creditor claims. Develop case strategies... ...5,000 - 125,000 USD per year (Remote (Coral Gables, FL, US)) #J-18...Remote workClaims
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