RN Medical Appeals & Claims Review Specialist
$30.5 - $59.47 per hourMolina Healthcare of Illinois
Molina Healthcare is seeking a Clinical Reviewer to provide support for medical claim and internal appeals review activities in North Las Vegas, NV. This role requires at least 2 years of clinical nursing experience including utilization review, along with a valid RN license in Nevada. The position involves facilitating clinical reviews, resolving complaints, and maintaining compliance with healthcare regulations. A competitive benefits and compensation package is offered, with pay ranging from $30.5 to $59.47 per hour. #J-18808-Ljbffr
$30.5 - $59.47 per hour
...Description Job Summary Provides support for medical claim and internal appeals review activities - ensuring alignment... ...and experience. Registered Nurse (RN) in Nevada. License must be active... ...(CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM...MedicalHourly payWork experience placementWork at office$30.5 - $59.47 per hour
...Healthcare in Las Vegas is seeking a skilled Registered Nurse for clinical support in medical claim reviews. Responsibilities include conducting thorough reviews of medical claims and appeals, ensuring compliance with state and federal regulations while contributing to high...MedicalHourly pay$43 - $63 per hour
...Description Job Description The Utilization Review Nurse plays a key role in evaluating... .... This position involves reviewing medical records, assessing clinical documentation,... ...Documentation Improvement Active Nevada RN license required Minimum 3 years of Utilization...MedicalRelocation package- ...healthcare provider is hiring a Utilization Review Nurse for an on-site position in Las Vegas... ...involves reviewing patient admissions for medical necessity and ensuring compliance with... ...guidelines. Candidates should have an active RN license in Nevada, over 5 years of acute...Medical
- ...national nonprofit organization is seeking a Registered Nurse (RN) to perform Clinical Review work and QIDP reviews. This remote position requires an... ...include applying Medicaid criteria to determine medical necessity, completing reviews within established timelines...MedicalRemote work
$41 - $64 per hour
...Job Description Job Description Utilization Review Nurse (RN) Location: Las Vegas, NV Job Type: Full-Time Pay: $41 – $64/hr... ...Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate resource utilization, and compliance...MedicalFull time$62.7k - $100.4k
...CareSource is seeking a Clinical Care Reviewer II in Las Vegas, NV, responsible for processing medical necessity reviews and coordination of care for members. Key functions... ...transitions. The ideal candidate will possess an RN license, a minimum of three years of clinical...Medical- ...personally and professionally. Position Overview We are seeking an RN to perform Clinical Review work and QIDP reviews. Team member will serve as the QIDP... ...Medicaid program criteria and guidelines to determine the medical necessity of health care services. Experience with...MedicalContract workRemote work
- ...serve our Nation's Heroes? Avosys is seeking a Surgical Case Nurse Reviewer to provide review services at Nellis Air Force Base Nevada.... ...the DoD NSQIP data base of all eligible patient cases within the medical treatment facility. The SCNR also works closely with the...MedicalFull timeFor contractorsWork at officeLocal areaRemote workMonday to FridayShift work
$2,500 per month
...Claims Specialist – Workers’ Compensation (Nevada) Ready to make a real impact? We’re looking for... ...’ Compensation claims, including medical-only cases. Maintain accurate and up-to... ...extent of injury and medical conditions. Review and handle other correspondence within...MedicalTemporary work$61.05k - $98.33k
...The WC Senior Claims Specialist handles complex and high-profile Workers' Compensation claims following... ...guidelines and participates in claims review as needed Develops and maintains... ...-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long...MedicalMinimum wageFull timeWork at officeLocal areaFlexible hours$2,500 per month
...Claims Specialist-WC Ready to make a real impact? We're looking for a sharp, proactive Claims... ...Workers' Compensation claims, including medical-only cases Maintain accurate and up-to-... ...of injury and medical conditions. Reviews and handles other correspondence within...MedicalHourly payFull timeTemporary workRemote work$15k
...Job Description Job Description The Utilization Review Nurse plays a critical role in assessing patient admissions to ensure appropriate... ...requirements. This position involves detailed analysis of medical charts and collaboration with case management teams to support...MedicalRelocation package- ...Claims Investigator Under direct supervision, develops the knowledge and skills needed... ...Investigates new claims by reviewing first reports of loss and supporting materials... ...legal liability, insurance coverage and medical terminology helpful, but not mandatory...MedicalWork at officeLocal areaImmediate startRemote work
$100k
...meet the unique coverage and claims-handling needs of businesses.... ...Construction Defect Technical Claims Specialist Employment Type: Full-... ...when it relates to reviewing large losses. Our entire... ...restrictions), denial of family and medical care leave, disability (...MedicalFull timeLocal areaRemote work- Overview The Senior Claims Specialist works within a Claims Team, using the latest technology to review, analyze, and process claims that are routinely characterized as moderately... ...independent adjusters, origin experts, and medical examiners; refer claim to subrogation group...MedicalWork experience placementLocal area
$53k - $69k
Job Description: As a member of our Claims team, utilize your knowledge of Workers Compensation... ...plans for case resolution including medical and disability management, litigation... ...face to face interactions during claims reviews, stewardship meetings and similar account...MedicalWork experience placement- ...Senior Claims Specialist The Senior Claims Specialist works within a Claims Team, using the latest technology to review, analyze and process claims that are routinely characterized as... ...and origin experts and independent medical examiners. Refers to claim to subrogation...MedicalWork experience placementWork at officeRemote work
$2,500 per month
...Claims Specialist-WC Ready to make a real impact? We're looking for a sharp, proactive Claims... ...Workers' Compensation claims, including medical-only cases Maintain accurate and up-to-... ...of injury and medical conditions. Reviews and handles other correspondence within...MedicalHourly payFull timeTemporary workRemote work- ...The University Medical Center of Southern Nevada is seeking a Registered Nurse for a per diem position focused on Utilization Management. This role involves reviewing patient admissions and ensuring adherence to standards and payer regulations. Candidates must possess...MedicalDaily paid
- ...University Medical Center of Southern Nevada (UMC) is seeking a Registered Nurse with extensive experience in acute hospital care and Utilization Management. The role involves reviewing patient admissions, analyzing medical charts, and ensuring compliance with third-party...MedicalDaily paid
$48k - $72k
Overview Description Workers' Compensation Claims Specialist Join GGRM Law Firm, Nevada's premier... ...adjusters, third party administrators, medical providers, and other relevant parties... ...regular basis to ensure each claim is reviewed at least once per month Meeting with the...MedicalWork at officeLocal areaFlexible hours- ...Fusion HCR Hiring: Utilization Review Nurse Fusion HCR is hiring! Direct hire – Utilization Review Nurse, this... ...Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance...Medical
- ...healthcare organization in Las Vegas is seeking a Registered Nurse to review patient admissions for appropriateness and compliance. The... ...in Utilization Management. Responsibilities include analyzing medical charts and collaborating on discharge planning. A valid Nevada...MedicalRelocation packageShift workWeekend work
$53 - $55 per hour
...compassionate and skilled Registered Nurse (RN) in the Las Vegas, NV area to administer... ...record Manage and administer prescribed medication, treatment, and therapies Conduct patient... ...compensation practices and regularly reviews our policies to ensure compliance with evolving...MedicalFull timeContract workLocal areaImmediate start- ...A leading academic medical center in Nevada is seeking a Registered Nurse with extensive experience in Utilisation Management. The role involves reviewing patient admissions and ensuring compliance with care standards. Candidates should possess a valid nursing license...Medical
$63 per hour
...Job Description Job Description Title: Utilization Review Nurse (RN) Department: Case Management Job Type: Full-Time Facility Details Academic Medical Center Nevada’s: Level I Trauma Center Verified Burn Center Transplant Center First...MedicalHourly payFull time$15k
...Sign on bonus may apply up to $15,000 Position Summary: Reviews patient admissions for appropriateness, efficiency of resource utilization... ...with third party payer requirements. Duties include analyzing medical charts, determining whether care provided is within established...MedicalWork at officeRelocation packageShift workWeekend work- ...International is seeking Registered Nurse (RN) Case Managers for full-time positions... ...support of theMike O'Callaghan Military Medical Center, Nellis AFB, NV ( . Apply online today... ...in program evaluation as directed. • Reviews referrals to case management for...MedicalFull timeContract workTemporary workFor contractorsWork at officeLocal areaMonday to FridayShift work
- ...documentation in CPRS, transfer logs, and electronic tracking systems. Reviews and synthesizes clinical data from multiple sources, including... ...health record (EHR), Joint Legacy Viewer (JLV), external medical records, and verbal reports. Collaborates with the Medical...MedicalPermanent employmentRemote workRelocation package
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