Job Title: Registered Nurse - Medical Claims Reviewer (FES Claims) Duration: 13 Weeks Schedule: 8-hour shifts | 8:00 AM - 05.00 PM | No Weekends Location: REMOTE (Willingness to attend 1-2 onsite training sessions if required) Must Have: Access to a personal laptop (remote desktop access will be provided) Certifications Required: Active RN License (Arizona) Basic Life Support (BLS) Fingerprint Clearance Card (must be obtained before start) Job Summary: We are seeking a highly motivated and detail-oriented Registered Nurse to serve as a Medical Claims Reviewer for FES 1500 claims. This position involves evaluating emergency medical claims to ensure accuracy, compliance with standards, and appropriate reimbursement practices. Candidates must be capable of working remotely with a high level of independence and discretion. Key Responsibilities: Conduct thorough reviews and adjudication of FES 1500 claims in line with standard industry guidelines Evaluate claims for emergency criteria, medical necessity, correct coding, length of stay, and level of care Collaborate with providers for second-level review when required Analyze claims data for reporting, trend identification, and savings tracking Participate in special projects and conduct research when assigned Apply InterQual criteria, CCI edits, and relevant regulations during claim assessments Required Knowledge & Competencies: Strong foundation in nursing practice, utilization review, and case management Proficiency in CPT, HCPCS, ICD-9 (ICD-10 preferred) coding systems Ability to assess medical documentation to determine appropriate care levels Knowledge of managed care protocols, InterQual Criteria, and CCI edits Understanding of AHCCCS and CMS regulatory requirements Competent in data entry and statistical analysis Independent worker with strong collaboration and communication skills Additional Requirements: Access to a personal laptop (remote desktop access will be provided) High school diploma or equivalent NavitsPartners
...an innovative Aerospace and Defense company that is seeking a Warehouse Manager to oversee and optimize their warehouse operations in... ...aspects of warehouse operations, including receiving, storing, and shipping materials. Ensure the efficient handling of goods, adherence...
...Free food & snacks ~ Opportunity for advancement ~ Paid time off ~ Training & development Join WonderPlay Brands as a Part-PPC Specialist and Help Us Inspire Wonder in the World! WonderPlay is the parent company of 5 brands focusing on inspiring wonder and...
...Position: Event manager / coordinator Location: Seattle, WA 98121 Duration: 8 Months Job Type: Contract Work Type: Onsite Payrate: $ 47.00 - 47.00/hr. Overview TekWissen is a global workforce management provider headquartered in Ann Arbor, Michigan...
...Contribution aux projets dvolution des infrastructures et de cyberscurit Profil : Solide matrise de Cisco (rseaux et WiFi), Fortinet et Palo Alto Expertise en protocoles de routage (BGP, OSPF), VLAN, VPN et pare-feu Connaissance des environnements haute...
...Host Healthcare is seeking a travel nurse RN OR - Operating Room for a travel nursing job in Fort Defiance, Arizona. Job Description &... ...company with an immediate opening for this Registered Nurse - PACU in Fort Defiance, AZ. If you are interested in this position, please...