- Molina Healthcare (Bellevue, WA)
- …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 (Bellevue, WA)
- …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 (Seattle, WA)
- …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
- Elevance Health (Seattle, WA)
- …enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently ... Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator Senior** is responsible for the independent… more
- Elevance Health (Seattle, WA)
- **Telephonic Nurse Case Manager I** **Location: Virtual:** **This role enables associates to work virtually full-time, with the exception of required in-person ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager I** is responsible for performing care...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisor's on the development of… more