High-speed internet (non-satellite) and a private, lockable home office Equipment : You will be ... Review medically complex claims , pre-authorization requests, appeals, and fraud/abuse referrals.
High-speed internet (non-satellite) and a private, lockable home office Equipment : You will be ... Review medically complex claims , pre-authorization requests, appeals, and fraud/abuse referrals.
High-speed internet (non-satellite) and a private, lockable home office Equipment : You will be ... Review medically complex claims , pre-authorization requests, appeals, and fraud/abuse referrals.
High-speed internet (non-satellite) and a private, lockable home office Equipment : You will be ... Review medically complex claims , pre-authorization requests, appeals, and fraud/abuse referrals.
Non-Union Wood Framing Inspector
$40 - $60/hr
Non-Union Wood Framing Inspector Twining Consulting, Inc., an innovative engineering, testing, and ... Review of approved plans vs. field installation (CBC compliance) * Inspection of shear wall ...
Non-Union Wood Framing Inspector
$40 - $60/hr
Non-Union Wood Framing Inspector Twining Consulting, Inc., an innovative engineering, testing, and ... Review of approved plans vs. field installation (CBC compliance) * Inspection of shear wall ...
Non-Union Wood Framing Inspector
$40 - $60/hr
Non-Union Wood Framing Inspector Twining Consulting, Inc., an innovative engineering, testing, and ... Review of approved plans vs. field installation (CBC compliance) * Inspection of shear wall ...
Non-Union Wood Framing Inspector
$40 - $60/hr
Non-Union Wood Framing Inspector Twining Consulting, Inc., an innovative engineering, testing, and ... Review of approved plans vs. field installation (CBC compliance) * Inspection of shear wall ...
SEIU Union Organizer-in-Training East Coast
Boston, MA · On-site
$56K/yr
Conducting broad and intensive outreach efforts to non-union workers. * Building one-on-one ... For further information, please review the Know Your Rights notice from the Department of Labor.
SEIU Union Organizer-in-Training East Coast
Boston, MA · On-site
$56K/yr
Conducting broad and intensive outreach efforts to non-union workers. * Building one-on-one ... For further information, please review the Know Your Rights notice from the Department of Labor.
SEIU Union Organizer-in-Training, Midwest Region
Chicago, IL · On-site +1
$56K/yr
Conducting broad and intensive outreach efforts to non-union workers. * Building one-on-one ... For further information, please review the Know Your Rights notice from the Department of Labor.
SEIU Union Organizer-in-Training, Midwest Region
Chicago, IL · On-site +1
$56K/yr
Conducting broad and intensive outreach efforts to non-union workers. * Building one-on-one ... For further information, please review the Know Your Rights notice from the Department of Labor.
Keeley Construction is actively seeking skilled and dependable Non -Union craft professionals ... Next Steps / Call to Action We encourage you to regularly review our open positions and apply to ...
Keeley Construction is actively seeking skilled and dependable Non -Union craft professionals ... Next Steps / Call to Action We encourage you to regularly review our open positions and apply to ...
Non Union Commercial Superintendent
Queens, NY · On-site
$43 - $45/hr
... for a Non-Union Commercial Building Superintendent with at least 5 years of experience with ... Ability to review and interpret work orders, operating instructions, diagrams, building plans, and ...
Quick apply
Non Union Commercial Superintendent
Queens, NY · On-site
$43 - $45/hr
... for a Non-Union Commercial Building Superintendent with at least 5 years of experience with ... Ability to review and interpret work orders, operating instructions, diagrams, building plans, and ...
Keeley Construction is actively seeking skilled and dependable Non -Union craft professionals ... Next Steps / Call to Action We encourage you to regularly review our open positions and apply to ...
Quick apply
Keeley Construction is actively seeking skilled and dependable Non -Union craft professionals ... Next Steps / Call to Action We encourage you to regularly review our open positions and apply to ...
The Pre-Claim Review Coordinator will review all Medicare episodes in assigned RCD state(s) to ... non-affirmation, claim rejection, or claim ADR. 6. Organizes submission packets and uploads to ...
The Pre-Claim Review Coordinator will review all Medicare episodes in assigned RCD state(s) to ... non-affirmation, claim rejection, or claim ADR. 6. Organizes submission packets and uploads to ...
Non-Union Relief Driver (Frederickson, WA)
Tacoma, WA · On-site
$37 - $38.50/hr
... review. Why Join Waste Connections? * Local routes - be home every night * Highly competitive pay ... As a Non-Union Relief Driver, you"'ll operate a garbage truck on assigned routes to safely collect ...
Non-Union Relief Driver (Frederickson, WA)
Tacoma, WA · On-site
$37 - $38.50/hr
... review. Why Join Waste Connections? * Local routes - be home every night * Highly competitive pay ... As a Non-Union Relief Driver, you"'ll operate a garbage truck on assigned routes to safely collect ...
The Pre-Claim Review Coordinator will review all Medicare episodes in assigned RCD state(s) to ... non-affirmation, claim rejection, or claim ADR. 6. Organizes submission packets and uploads to ...
The Pre-Claim Review Coordinator will review all Medicare episodes in assigned RCD state(s) to ... non-affirmation, claim rejection, or claim ADR. 6. Organizes submission packets and uploads to ...
Keeley Construction is actively seeking skilled and dependable Non -Union craft professionals ... Next Steps / Call to Action We encourage you to regularly review our open positions and apply to ...
Keeley Construction is actively seeking skilled and dependable Non -Union craft professionals ... Next Steps / Call to Action We encourage you to regularly review our open positions and apply to ...
Pre-Claim Review Coordinator - ProHealth Home Health and Hospice (Pensacola, FL.)
Pensacola, FL · On-site
The Pre-Claim Review Coordinator will review all Medicare episodes in assigned RCD state(s) to ... non-affirmation, claim rejection, or claim ADR. 6. Organizes submission packets and uploads to ...
Pre-Claim Review Coordinator - ProHealth Home Health and Hospice (Pensacola, FL.)
Pensacola, FL · On-site
The Pre-Claim Review Coordinator will review all Medicare episodes in assigned RCD state(s) to ... non-affirmation, claim rejection, or claim ADR. 6. Organizes submission packets and uploads to ...
The Pre-Claim Review Coordinator will review all Medicare episodes in assigned RCD state(s) to ... non-affirmation, claim rejection, or claim ADR. 6. Organizes submission packets and uploads to ...
The Pre-Claim Review Coordinator will review all Medicare episodes in assigned RCD state(s) to ... non-affirmation, claim rejection, or claim ADR. 6. Organizes submission packets and uploads to ...
... and non-union professionals, across the Veit Enterprise. This position manages full-cycle ... reviewing resumes, conducting phone interviews, and issuing employment offers via the applicant ...
... and non-union professionals, across the Veit Enterprise. This position manages full-cycle ... reviewing resumes, conducting phone interviews, and issuing employment offers via the applicant ...
... reviewed presentations/publications, or related dissertation topic. Knowledge of Brightspace and Zoom, preferred. Excellent oral and written communication skills and ability to communicate with a ...
... reviewed presentations/publications, or related dissertation topic. Knowledge of Brightspace and Zoom, preferred. Excellent oral and written communication skills and ability to communicate with a ...
Lecturer-Non-Union
Chicago, IL · On-site
... peer-reviewed presentations/publications, or related dissertation topic. • Knowledge of Brightspace and Zoom, preferred. • Excellent oral and written communication skills and ability to ...
Lecturer-Non-Union
Chicago, IL · On-site
... peer-reviewed presentations/publications, or related dissertation topic. • Knowledge of Brightspace and Zoom, preferred. • Excellent oral and written communication skills and ability to ...
Non-Union Engineer
$45 - $50/hr
... reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If ...
Non-Union Engineer
$45 - $50/hr
... reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If ...
Non-Union Engineer
San Diego, CA · On-site
$45 - $50/hr
... reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If ...
Non-Union Engineer
San Diego, CA · On-site
$45 - $50/hr
... reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If ...
Non Union Claim Reviewer information
What cities are hiring for Non Union Claim Reviewer jobs? Cities with the most Non Union Claim Reviewer job openings:
What are the most commonly searched types of Claim Reviewer jobs? The most popular types of Claim Reviewer jobs are:
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Job description
Max Salary: W-2 ($65,000/$31.25)
Location: Remote (U.S. - Work from home)
Remote Work Requirements: High-speed internet (non-satellite) and a private, lockable home office
Equipment: You will be provided with all necessary equipment to perform your job effectively, including but not limited to a desktop computer, dual monitors, a headset, an ethernet cable, and additional accessories as needed.
We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team. This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines. The ideal candidate will use their clinical expertise to assess medical necessity, appropriateness, and reimbursement eligibility while documenting decisions in accordance with regulatory and organizational requirements.
Key Responsibilities- Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
- Assess payment determinations using clinical information and established guidelines.
- Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
- Provide clear, well-documented rationales for service approvals or denials.
- Educate internal and external teams on medical review processes, coverage determinations, and coding requirements.
- Support quality control activities to meet corporate and team objectives.
- Provide guidance to LPN team members and support non-clinical staff through training and discussions.
- Assist with special projects and additional responsibilities as assigned.
- Active, unrestricted RN license in the U.S. and in the state of hire
OR - Active compact multistate RN license (as defined by the Nurse Licensure Compact).
- Associate Degree in Nursing
OR - Graduate of an accredited School of Nursing.
- Two years of clinical experience.
- Strong clinical background in managed care, home health, rehabilitation, and/or medical-surgical settings.
- Ability to interpret and apply medical review criteria and clinical guidelines.
- Proficiency in Microsoft Office and word processing software.
- Strong analytical, organizational, and decision-making skills.
- Ability to work independently while managing priorities effectively.
- Excellent customer service, communication, and critical thinking skills.
- Ability to handle confidential information with discretion.
About BROADWAY VENTURES
Sourced by ZipRecruiter
Industry
Business management consulting
Company size
11 - 50 Employees
Headquarters location
Canton, MS, US
Year founded
2013