- Molina Healthcare (Fort Worth, TX)
- JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring ... hospital setting, including at least 1 year of utilization review , medical claims review...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Fort Worth, TX)
- …work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and ... Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in … more
- Molina Healthcare (Fort Worth, TX)
- For this position we are seeking a ( RN ) Registered Nurse who...for a RN with experience with appeals, claims review , and medical coding. ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… more
- Baylor Scott & White Health (Dallas, TX)
- **JOB SUMMARY** The Denial Resource Center Registered Nurse ( RN ) is responsible for Baylor Scott & White Health denial management functions. The Denial ... - Associate's - EXPERIENCE - 2 Years of Experience - CERTIFICATION/LICENSE/REGISTRATION - Registered Nurse ( RN ) Hybrid expectation- On-site once a year… more
- Molina Healthcare (Fort Worth, TX)
- …Microsoft Excel (edit/save spreadsheets, sort/filter) **Required License, Certification, Association** Licensed registered nurse ( RN ), Licensed practical ... internal policies, and contract requirements. This position completes a medical review to facilitate a referral to...corresponding medical records to determine accuracy of claims payments. + Review of applicable policies,… more
- Sedgwick (Irving, TX)
- …providers to support the claim request and documents decision rationale. + Completes medical review of all claims by reviewing medical documentation ... clinical evaluations on claims that require additional review based on medical condition, client requirement,... management of claims including comprehension of medical terminology and substantiating claim decisions. **ADDITIONAL… more
- Health Care Service Corporation (Richardson, TX)
- …document findings.** **Organizational skills and prioritization skills** **Preferred Job Qualifications:** ** Registered Nurse ( RN ) with unrestricted license ... special investigations, customer service, pass, network management, marketing, case management, medical review , legal, pricing and database. **Required Job… more
- Elevance Health (Grand Prairie, TX)
- …+ Travels to worksite and other locations as necessary + BA/BS preferred + Medical claims review with prior health care fraud audit/investigation experience ... you will make an impact:** + Investigates potential fraud and over-utilization by performing medical reviews via prepayment claims review and post payment… more
- Sedgwick (Fort Worth, TX)
- … review of referred claims ; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. ... + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made on claims .… more
- Molina Healthcare (Fort Worth, TX)
- …or equivalent combination of relevant education and experience. * Advanced Practice Registered Nurse (APRN) license. License must be active and unrestricted ... claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees...officer. * Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review … more
- Sedgwick (Fort Worth, TX)
- …the ADA process for claimants requesting accommodations under the ADAAA; to review complex medical information for temporary and permanent accommodation ... and/or client requirements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Reviews medical information for ADAAA temporary and permanent accommodation requests. +… more
- Elevance Health (Grand Prairie, TX)
- **Telephonic Nurse Case Manager II** **$3000 Sign-On Bonus** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more