- Molina Healthcare (Akron, OH)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... **Job Duties** + Performs clinical/ medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which… more
- Molina Healthcare (Akron, OH)
- …to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. ... nursing experience with broad clinical knowledge. + Five years experience conducting medical review and coding/billing audits involving professional and facility… more
- Molina Healthcare (Akron, OH)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of… more
- Elevance Health (Independence, OH)
- …network management input and dollar volume of provider. + Analyzes data to select claims to be reviewed, conducts reviews using medical charts, medical ... notes, and provider contracts. + Verifies dollar amount on claim is correct in claims system and...education and experience, which would provide an equivalent background. RN , LPN or medical coding certification strongly… more
- Elevance Health (Independence, OH)
- …and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a ... experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing… more
- Cleveland Clinic (Beachwood, OH)
- …Graduate from an accredited school of Professional Nursing + Current state licensure as a Registered Nurse ( RN ) + Three years of clinical nursing experience ... respected healthcare organizations in the world. As Disability Plan Nurse , you will primarily review short-term disability...appropriate utilization of benefit plans. + Prepare background and medical data for use in committee review … more