- Molina Healthcare (Las Cruces, NM)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... schedule) Looking for a RN with experience with appeals, claims review , and medical coding....clinical/ medical reviews of retrospective medical claim reviews, medical claims and… more
- Molina Healthcare (Las Cruces, NM)
- …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
- Molina Healthcare (Las Cruces, NM)
- …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
- Community Health Systems (Las Cruces, NM)
- …incident reporting, and corrective actions to mitigate risk. + Manages claims and litigation processes, coordinating with legal counsel and maintaining detailed ... regarding real and potential risk issues. + Ensures accurate management and review of occurrence reporting systems, analyzing data to identify trends and implement… more