- Healthfirst (UT)
- …Reduction, Termination, and Suspension of services. The end-to-end process requires the Specialist to independently: + Research issues + Quality of Care Experience + ... + Work within a framework that measures productivity and quality for each Specialist against expectations + Prepare cases for Medical Director Review ensuring that… more
- Molina Healthcare (UT)
- … appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of ... these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. **Preferred… more