- Molina Healthcare (Dallas, TX)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals ... Friday 8:00am - 5:00pm Central time Remote position **Essential Job Duties** * Performs clinical /medical reviews of previously denied cases in which a formal … more
- Molina Healthcare (Dallas, TX)
- …and holiday rotation. Michigan RN license is required. **Job Duties** + Facilitates clinical /medical reviews of retrospective medical claim reviews , medical ... judge pre-hearings, state insurance commissions, and judicial fair hearings. + Reviews medically appropriate clinical guidelines and other appropriate criteria… more
- Molina Healthcare (Dallas, TX)
- …national, state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses required for ... reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves...reviews cases requiring concurrent review, and manages the denial process. + Monitors appropriate care and services through… more
- Molina Healthcare (Dallas, TX)
- …issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical ... * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for...reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care and services through… more