Medical Review Nurse (RN) Molina Healthcare IncMedical Review Nurse (RN)Henderson, 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 SpecialistLas Vegas, 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 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 Review Officer (MRO) - Bid MaximusMedical Review Officer (MRO) - BidLas Vegas, 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 US Department of Health and Human ServicesMedical Records TechnicianNV$37,193–$44,780 / yearRefer 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. Required 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."
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.
Lead Reviewing Physician Consultant (Bid) MaximusLead Reviewing Physician Consultant (Bid)Las Vegas, 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)Las Vegas, 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)Las Vegas, 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.
Medical Director Veterinarian AmeriVetMedical Director VeterinarianLas Vegas, NevadaEvaluate, develop, and continuously improve clinical competency across the veterinary team , including doctors, relief doctors, veterinary assistants, and technicians, through direct observation, coaching, case discussions, and periodic medical record reviews to elevate medical quality and consistency of care. In close partnership with the Practice Manager, the MD provides medical oversight of hospital operations and care delivery to ensure consistently exceptional outcomes for patients, clients, and team members, and achievement of performance metrics and business goals.
Medical 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 Concentra Inc.Physician Associate Director of Medical OperationsLas Vegas, NV$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.
Medical Office Clerk - OB/GYN Clinic DecypherMedical Office Clerk - OB/GYN ClinicNellis AFB, NVJob Summary: The Medical Office Clerk serves as the first point of contact for patients and visitors by providing exceptional customer service, scheduling appointments, managing phone communications, and coordinating patient access to healthcare services. This role maintains accurate medical records, supports healthcare providers with administrative and clerical functions, ensures the integrity of appointment and patient record systems, and contributes to the efficient daily operation of the medical clinic.
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)Las Vegas, 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.
NewMedicaid Quality Management Health Plan Director Elevance Health IncMedicaid Quality Management Health Plan DirectorLas Vegas, NVProven ability to lead in a highly matrixed environments as well as partnering with clinical, network, analytics, and external stakeholders while facilitating governance forums and driving accountability across teams strongly preferred. Extensive experience leading large-scale, cross-functional initiatives involving data integration, reporting infrastructure, and partnership with IT and analytics teams (e.g., HIE or similar data exchange efforts) strongly preferred.