Medical Review Nurse - Glenview - Guarantee Trust

We're seeking candidates who are looking for meaningful work, who want to invest in their growth, and contribute to a company built on timeless virtues and best business practices. · ...

Guarantee Trust Life Insurance Company (GTL) is seeking a Medical Review Nurse to join their team in Glenview, IL. The ideal candidate will have a solid clinical nursing background and prior insurance experience. · Evaluate claims for Hospital Indemnity, Medicare Supplement, Long ...

Guarantee Trust Life Insurance Company is currently seeking a Medical Review Nurse to join our team. · We're seeking candidates who are looking for meaningful work, who want to invest in their growth and contribute to a company built on timeless virtues and best business practice ...

This role enables associates to work virtually full-time with the exception of required in-person training sessions providing maximum flexibility and autonomy. · Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets m ...

This role enables associates to work virtually full-time with maximum flexibility and autonomy. Conducts initial medical necessity clinical screenings of preauthorization request to assess assessing the medical necessity of diagnostic imaging procedures out of network services an ...

+Job summary · Lensa does not hire directly for these jobs but promotes them on behalf of its direct clients. · +Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations. · Evaluates documentation/information to de ...

This role enables associates to work virtually full-time, except for required in-person training sessions.This approach promotes productivity and supports work-life integration. · This approach promotes productivity and supports work-life integration. · ...

This position is responsible for ensuring compliance of the Utilization Management (UM) and Quality Review (QR) functions performed by the Medical Groups/IPAs participating in the networks of client's HMOs. · ...

This position performs medical review of claims suspended for medical necessity using medically accepted criteria. · Candidates must reside in TX or IL · ...

The Quality Review Nurse ensures Utilization Management (UM) and Quality Review (QR) compliance for Medical Groups/IPAs within the HMO network. · ...

The Nurse Reviewer II is responsible for collaborating with healthcare providers and members to promote the most appropriate use of diagnostic imaging. They conduct medical necessity clinical screenings and determine if initial clinical information meets medical necessity criteri ...

The Nurse Reviewer II role enables associates to work virtually full-time, except for required in-person training sessions. This approach promotes productivity and supports work-life integration. · This position is responsible for collaborating with healthcare providers and membe ...

This position is responsible for ensuring compliance of the Utilization Management (UM) and Quality Review (QR) functions performed by the Medical Groups/IPAs participating in the networks of client's HMOs. · 3 years clinical experience with 2 years' experience in utilization rev ...

This role supports the end-to-end appeals process to ensure timely, accurate, · and compliant resolution of member and provider appeals.This is a full-time position · with required participation in a rotating holiday schedule (3–4 holidays per year) and one weekend every third we ...

Job summary · Registered Nurses – are you looking for a change? Want to work no nights, no weekends and no holidays? · Competitive salary and benefits · No weekends and nights · ...

This position involves utilizing clinical knowledge and communication skills to obtain patient-specific information regarding patient condition and proposed treatments and procedures. The role requires certification of treatment for confinement when certain criteria are met. · Co ...

Hines & Associates offers a nationwide managed health care service with comprehensive services and cost containment. As a Registered Nurse, you will work in a hybrid setting (once trained), enjoying competitive salary and benefits, including medical, dental, vision, long-term car ...

+ Job summary: Utilization Review Registered Nurse position available at Hines & Associates with competitive salary and benefits. Work-life balance and remote/hybrid setting (once trained). · + Qualifications: RN license, recent acute clinical practice required. · + Responsibilit ...

Coordinate and perform all aspects of Worker's Compensation, auto, and general liability claims for medical management activity (IME/Peer Review, UR) to ensure optimum medical care service delivery. · ...

Nurses – are you looking for a change? Want to work no nights, no weekends, · and no holidays? Be able to work from home 50% of the time once trained? · ...

Nurses in a change want to work no nights weekends and holidays be able to work from home 50% of the time once trained check out Hines & Associates. · ...