- Molina Healthcare (Dallas, TX)
- …to provide quality and cost-effective member care. This position will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with ... The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory… more
- Guardian Life (Plano, TX)
- …compliant with applicable state regulations. You will ensure that claims, referrals, appeals , and grievances meet state specific regulations, timeframes, and ... Review & ensure that determination and processing of claims, referralsand appeals meet state regulations, time frames& definitions. + Completeadjudication of retail… more
- Molina Healthcare (Dallas, TX)
- …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse… more