- Molina Healthcare (Kenosha, WI)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... **Job Duties** + Performs clinical/ medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which… more
- Molina Healthcare (Kenosha, WI)
- …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 (Kenosha, WI)
- …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
- AbbVie (Mettawa, IL)
- …innovation in scientific strategy and standards including Scientific Platform, CFL, SIUU, and Medical Review . + Lead the strategic redesign and implementation of ... promotional resources and driving process efficiencies. + Ensure consistent Medical Review onboarding and ongoing training /...capabilities (US Digital Lab & International) related to core claims and material review , to effectively scale… more