- Medical Mutual of Ohio (OH)
- …workplace and perform pre-employment substance abuse and nicotine testing._ **Title:** _Clinical Appeal & Claim Review Nurse II_ **Location:** _Ohio_ ... + Independently evaluates basic to complex medical claims and/or appeal cases and associated records by applying clinical , regulatory, and… more
- Molina Healthcare (Cincinnati, OH)
- …+ Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience ... + Performs clinical /medical reviews of retrospective medical claim reviews, medical claims and previously denied...reports quality of care issues. + Assists with Complex Claim review including DRG Validation, Itemized Bill… more
- Molina Healthcare (OH)
- …of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and...specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long… more
- Evolent (Columbus, OH)
- …interact with coordinators who set up the appeal , physicians and other clinicians who review the appeal , the claims department to review provider ... adjudication of processed appeals. **What You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review as an LPN or LVN… more
- Evolent (Columbus, OH)
- …request. + Submitting IT tickets to address barriers to generating cases for clinical review and following the ticket through to completion. + Addressing ... our daily operations this individual also works with our clinical team, which includes our medical reviews: LVNs, LPNs,...prior authorization requests and/or relevant health care experience in claims or appeal & grievances is required.… more