• Medical Claim Review

    Molina Healthcare (Madison, WI)
    …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...Claims Auditing, Medical Necessity Review and Coding experience +… more
    Molina Healthcare (07/12/25)
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  • NCCPAC Revenue Utilization Review (RUR)…

    Veterans Affairs, Veterans Health Administration (Middleton, WI)
    Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of the ... RXs, Care in the Community, DME, and Ambulance. Conducts clinical legal relatedness review for Regional Counsel TORT Claims , No Fault, and Worker's Compensation… more
    Veterans Affairs, Veterans Health Administration (07/03/25)
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  • Investigator, Coding SIU

    Molina Healthcare (Madison, WI)
    claims with corresponding medical records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines, and provider ... policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or… more
    Molina Healthcare (06/19/25)
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  • Medical Director (CT)

    Molina Healthcare (Madison, WI)
    …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
    Molina Healthcare (07/11/25)
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