- Molina Healthcare (Vancouver, 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 (Vancouver, 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
- CareOregon (Portland, OR)
- …teams and resources. Areas of oversight include prior authorizations, referrals, concurrent review , and durable medical equipment (DME). This includes the ... programs and services to ensure the use of CareOregon resources meet medical appropriateness and least costly alternative criteria; this entails oversight of… more