- Molina Healthcare (Long Beach, CA)
- …clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review . **Required License, Certification, Association** Active, ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...of proactive approaches to improve and standardize overall retrospective claims review . * Ensures core system is… more
- Emanate Health (Covina, CA)
- …decisions using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete ... States, and the #19 ranked company in the country. **Job Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity… more
- Guardian Life (Harrisburg, PA)
- …providers to obtain certification dates, treatment plans and any other pertinent medical information necessary to facilitate and assist claims managers in ... disability claims decision. They will leverage their medical knowledge to determine what medical information...treatment is maintained via continuing education **You will** + Review information in file, obtain medical information… more
- HCA Healthcare (San Antonio, TX)
- …and/or balances. Analyzes accounts for specialized billing requirements that require a review of the medical record documentation, regulatory information, and ... and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low… more
- CVS Health (MI)
- …frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management ... and support safe transitions. **REQUIRED EXPERIENCE** - 2 years Licensed Vocational Nurse ( LVN ) nursing experience - Active and unrestricted State of Michigan LVN… more
- HCA Healthcare (Salem, VA)
- …our Medical Necessity Coding Compliance Coordinator opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. ... VA). Do you have the career opportunities as a Medical Necessity Coding Compliance Coordinator you want with your...you will do in this role:** + Coordinate NCD/LCD/LCA review process at the Division level + Determine whether… more
- ICW Group (San Diego, CA)
- …required; ensures quality and appropriate service delivery. + Communicates effectively with medical providers, the assigned claims examiner, injured worker and ... clinical assessment and evaluate needs for treatment in worker's compensation claims . The Telephonic Nurse Case Manager will negotiate and coordinate appropriate… more