- Molina Healthcare (Grand Rapids, MI)
- JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring ... hospital setting, including at least 1 year of utilization review , medical claims review...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Grand Rapids, MI)
- …work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and ... Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in … more
- CVS Health (Grand Rapids, MI)
- …are not permitted. **Required Qualifications** + 3+ years clinical practical experience as an Registered Nurse ( RN ) + Candidate must have active and ... all case management activities with members to evaluate the medical needs of the member to facilitate the member's...unrestricted Michigan Registered Nurse ( RN ) licensure +… more
- Sedgwick (Grand Rapids, MI)
- … review of referred claims ; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. ... + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made on claims .… more