- Molina Healthcare (Tacoma, 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 (Tacoma, 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
- Veterans Affairs, Veterans Health Administration (Tacoma, WA)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... that care is coordinated, collaborative, and integrated within the Medical Center. Develops, implements, and documents the mental health...Program (MHRRTP). Primary responsible for phone consultation to the RN staff in the MHRRTP, and in cases of… 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