- CVS Health (Salt Lake City, UT)
- …As a QM Nurse Consultant you will be responsible for the review and evaluation of clinical information and documentation. + Reviews documentation and interprets ... medical records and system documentation to evaluate post-service claims for payment based on clinical policies, legislation, regulatory requirements, and… more
- Molina Healthcare (Midvale, UT)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
- R1 RCM (Salt Lake City, UT)
- …experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical records and payer denial information submitted by clients ... justified for that hospital stay or service using evidence-based guidelines. + Review governmental regulations, payer protocols, and/or medical policy to… more
- Molina Healthcare (West Valley City, UT)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- Public Consulting Group (Salt Lake City, UT)
- …and on a team. + Proven working experience in case management, including as a nurse , medical , mental health care manager or a related job + Excellent knowledge ... Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + Cost… more
- CVS Health (Salt Lake City, UT)
- …Manager role includes: -Collaborate with an interdisciplinary care management team ( nurse case managers, medical directors, dietitians, social workers) to ... path to better health, decrease hospital readmissions, and reduce medical costs. -Conducts comprehensive medication reviews then telephonically outreaches patients… more
- CVS Health (Salt Lake City, UT)
- …Plans - Coordinates and arranges for health care service delivery under the direction of nurse or medical direction of medical direction in the appropriate ... Care Management Associate you will be supporting comprehensive coordination of medical services including Care Team intake, screening and supporting the… more