Medical Review Nurse (RN) Molina Healthcare IncMedical Review Nurse (RN)North Las Vegas, NVReevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions. REQUIRED QUALIFICATIONS: At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience.
ROI Medical Records Specialist MRO CorporationROI Medical Records SpecialistReno, Nevada$16–$22 / hourFull timeResponsibilities: Determines records to be released by reviewing requestor information in accordance with HIPAA guidelines and obtaining pertinent patient data from various sources, including electronic, off-site, or physical records that match patient request. Overview: The ROI Specialist is responsible for providing support at a specified client site for the Release of Information (ROI) requests for patient medical record requests*.
Medical Review Officer (MRO) - Bid MaximusMedical Review Officer (MRO) - BidReno, NVFull timeMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. - After completing all research, the physician must write a case rationale in the correct format that introduces the question at hand, summarizes the correct guideline, analyses the pertinent case details related to the guideline, and then make a final determination as to the medical necessity of the requested service.
Medical Records Technician (Coder) US Department of Health and Human ServicesMedical Records Technician (Coder)NV$50,460–$72,644 / yearRequired as applicable for the purposes of specific eligibility and appointment claim(s), and position requirements: Indian Preference Applicants: If claiming Indian preference, applicants must provide a completed copy of the Form BIA-4432, "Verification of Indian Preference for Employment in the BIA and IHS Only." Refer to BIA-4432 link: Verification of Indian Preference for Employment in the BIA and IHS When an Indian Preference candidate possesses Veterans preference the rules regarding Veterans preference apply under ESEP and the applicant must provide documentation in order to receive preference.
Medical Records Technician Desert Parkway Behavioral Healthcare HospitalMedical Records TechnicianLas Vegas, NV$18Strong organizational skills with ability to prioritize projects, work relatively independently, manage multiple tasks, and meet deadlines. Serve as a liaison between healthcare providers and staff regarding the availability of patient records.
Medical Records Technician US Department of Health and Human ServicesMedical Records TechnicianWadsworth, NVMENU Sign in My jobs Profile Resumes & documents Search preferences Notifications Sign out My jobs Profile Resumes & documents Notifications Search preferences Sign out Events Help Center Search Back to results Apply Medical Records Technician Department of Health and Human Services Indian Health Service Various locations across the Agency Apply Print Share Save. Perform a variety of medical records technician duties which include the complete and accurate process and maintenance of hybrid paper-electronic environment of analyzing filing compiling scanning releasing information retrieving and dispatching charts and documents file managing archiving Third Party and entering data of treatment provided to patients within a complex health care facility.
Clinical Quality Review Team Lead TriWest Healthcare AllianceClinical Quality Review Team LeadLas Vegas, NVRemoteFull timeThe team lead supports clinical and non-clinical staff supporting CQM programs by providing training and onboarding of new staff; determining work assignments; performing audits for clinical records and/or work accuracy; and ensuring effective, consistent and accurate workflow. Technical Skills: Comprehensive knowledge of research methodology; proficient applying appropriate data analysis processes; knowledge of managed care principles and methods; knowledge in the application of clinical criteria; proficient with Microsoft Word, Excel, and PowerPoint.
Corporate Fair & Responsible Banking Analyst-Loan Review Glacier Bancorp IncCorporate Fair & Responsible Banking Analyst-Loan ReviewNV$75,663.07–$113,494.60 / yearStrong knowledge of Fair Lending regulations is required: Home Mortgage Disclosure Act, Equal Credit Opportunity Act, Fair Housing Act, Service Members Civil Relief Act, Fair Debt Collection Practices Act, Fair Credit Reporting Act, Truth In Lending Act, Unfair Deceptive or Abusive Acts or Practices, Real Estate Settlement Procedures Act, Mortgage Acts and Practices. Key responsibilities include fair lending and compliance reviews, lead FARB's risk assessment program, and the oversight of FARB-related models and non-model tools in partnership with analysts, ERM-Model Risk Management, and other stakeholders.
Lead Reviewing Physician Consultant (Bid) MaximusLead Reviewing Physician Consultant (Bid)Reno, NVFull timeAfter completing all research, the physician must write a case rationale in the correct format that introduces the question at hand, summarizes the correct guideline, analyses the pertinent case details related to the guideline, and then make a final determination as to the medical necessity of the requested service. Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Mental Health Reviewing Consultant (Bid) MaximusMental Health Reviewing Consultant (Bid)Reno, NVFull timeMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. - After completing all research, the physician must write a case rationale in the correct format that introduces the question at hand, summarizes the correct guideline, analyses the pertinent case details related to the guideline, and then make a final determination as to the medical necessity of the requested service.
Alternate Vision Reviewing Physician Consultant (BID) MaximusAlternate Vision Reviewing Physician Consultant (BID)Reno, NVFull timeMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. - Maintain working knowledge of Office of Personnel Management (OPM) medical and suitability policies and ensure all consultations reflect current clinical best practices, regulatory requirements, and program objectives.
NewMedical Office Clerk - Family Practice Residency Training (FMR) Decypher Technologies, Ltd.Medical Office Clerk - Family Practice Residency Training (FMR)Nellis AFB, NVJob Summary: Medical Office Cleark will provide administrative and front-desk support in a healthcare setting by greeting patients, scheduling appointments, maintaining accurate medical records, and coordinating daily office operations. Serve as a liaison between patients, healthcare providers, hospitals, and community organizations while ensuring effective communication, patient eligibility verification, and timely access to medical services.
Physician Associate Director of Medical Operations ConcentraPhysician Associate Director of Medical OperationsLas Vegas, Nevada$250,000–$290,000 / yearThis position is eligible to earn a base compensation rate in the range of $250,000.00 to $290,000.00 annually depending on job-related factors as permitted by applicable law, such as level of experience, geographic location where the work is performed, and/or seniority. Excellent communication skills including speaking, presentation, listening, telephone, negotiation, business and medical writing skills necessary to convey information to supervisors, peers, or customers.
NewMedical Office Clerk - Family Practice Residency Training (FMR) DecypherMedical Office Clerk - Family Practice Residency Training (FMR)Nellis AFB, NEVADAJob Summary: Medical Office Cleark will provide administrative and front-desk support in a healthcare setting by greeting patients, scheduling appointments, maintaining accurate medical records, and coordinating daily office operations. Serve as a liaison between patients, healthcare providers, hospitals, and community organizations while ensuring effective communication, patient eligibility verification, and timely access to medical services.
Registered Nurse - Utilization Manager ERP InternationalRegistered Nurse - Utilization ManagerNellis AFB, NV$34.26–$60 / hourCollaborates with staff/departments, including, but not limited to: Executive Management, Resource Management, Medical Records, Patient Administration, Group Practice Managers, Health Care Integrator Consultants, Medical Management team, SGH (Chief of Medical Staff), Coders/Coding Auditors, Medical Management, Referral Management, TRICARE Operations, patient care teams, Quality Improvement, and the Managed Care Support Contractors. • Must be able to collect clinical data from inpatient and outpatient sources; provide documentation for appeals or grievance resolution; apply critical thinking skills and expertise in resolving complicated healthcare, social, interpersonal, and financial patient situations; apply problem-solving techniques to articulate medical requirements to patients, families/care givers, medical and non-medical staff in a professional and courteous way.
RN Care Manager - Tucson, AZ and Las Vegas, NV ArchWell Health LLCRN Care Manager - Tucson, AZ and Las Vegas, NVLas Vegas, NVJob Summary: The Nurse Care Manager is responsible for helping coordinate and evaluate the management of patients with acute and chronic conditions, across the care continuum, to achieve high quality care measured by positive patient outcomes. In our medical clinics, we provide comprehensive primary care for senior adults with traditional Medicare and Medicare Advantage plans, focused on delivering improved quality, better patient experience and lower total cost of care.
Nurse Practitioner (Per Diem) ComplexCare SolutionsNurse Practitioner (Per Diem)Carson City, Nevada$2,400–$10,000 / yearPer diemAbility to practice autonomously in a remote clinical environment, including independently conducting patient assessments, formulating evidence-based treatment plans, managing complex chronic conditions, and making sound clinical decisions without direct on-site supervision. Pay Range: $2,400.00 - $10,000.00 per month (Potential income) Earnings will vary based on completed assessments, state of residence, and business needs as there is no guarantee of visits or minimum income.
Community Based Care Manager CareSourceCommunity Based Care ManagerNV$62,700–$100,400 / yearEssential Functions: Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivation interviewing to complete health and psychosocial assessments through a health equity lens unique to the needs of each member that identify the cultural, linguistic, social and environmental factors/determinants that shape health and improve health disparities and access to public and community health frameworks. Job Summary: The Community Based Care Manager collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based organizations to improve quality and meet the needs of the individual, natural supports and the population through culturally competent delivery of care and coordination of services and supports.
Community Based Care Manager CareSource Management ServicesCommunity Based Care ManagerNevadaEngage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivation interviewing to complete health and psychosocial assessments through a health equity lens unique to the needs of each member that identify the cultural, linguistic, social and environmental factors/determinants that shape health and improve health disparities and access to public and community health frameworks. The Community Based Care Manager collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based organizations to improve quality and meet the needs of the individual, natural supports and the population through culturally competent delivery of care and coordination of services and supports.