• RN Medical Claim Review Nurse Remote

    Molina Healthcare (Detroit, MI)
    …and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities....diagnosis. Candidates with knowledge of CPT/HCPCS codes, record review, chart audit , provider disputes, appeals, and 1500… more
    Molina Healthcare (10/19/25)
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  • Senior Overreader, HEDIS/Quality Improvement…

    Molina Healthcare (MI)
    …notes or feedback from the HEDIS audit . Makes recommendations based off of the audit and chart review. + Assists with ad hoc projects. + Participates in ... like projects and supplemental data collection. The overreader team will meet chart overread productivity standards, minimum over read standards, and 2nd overread… more
    Molina Healthcare (08/21/25)
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  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Dearborn, MI)
    …and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a ... **Diagnosis Related Group Clinical Validation Auditor- RN (CDI, MS-DRG, AP-DRG and APR-DRG)** **Virtual:** This...impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the… more
    Elevance Health (10/22/25)
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  • Patient Care Technician - PCT - Dialysis Preceptor

    Fresenius Medical Center (Albion, MI)
    …PCT III HT are to be performed under the direct supervision of the Home Therapies registered nurse (HT RN ), in compliance with, and as permissible per state ... for patients under the direct supervision of a licensed nurse under organization policies, procedures, and training and in...processes and rapport with patients, care partners, the HT RN , direct and non-direct patient care staff, providers, and… more
    Fresenius Medical Center (10/17/25)
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  • Clinical Quality Nurse Specialist

    Hospice of Michigan (Kalamazoo, MI)
    …every time, 100% of the time. Qualifications: + Bachelor of Science in Nursing preferred. Registered Nurse ( RN ) licensure in the State of Michigan required. ... support of the mission of NorthStar Care Community. The Clinical Quality Nurse Specialist is responsible, through monitoring and supporting clinical staff, for… more
    Hospice of Michigan (08/09/25)
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  • Director, Clinical Data Acquisition

    Molina Healthcare (MI)
    …Adjustment, is responsible for the implementation, monitoring, and oversight of all chart collection for Risk Adjustment, RADV, or Risk Adjustment-like projects, and ... other state specific audit projects and deliverables related to accurate billing and...training, onboarding for CDA team members, vendor management for chart collection vendors, Supplemental data, and chart … more
    Molina Healthcare (10/22/25)
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  • Revenue Integrity - Nurse Auditor

    Trinity Health (Ann Arbor, MI)
    …travelling between locations within the region. **MINIMUM QUALIFICATIONS** **Licensure/Certification:** Registered Nurse or Licensed Vocational Nurse / ... optimization. Investigates denials and root causes, which includes performing thorough chart reviews, providing education to clinical colleagues, and tracking of… more
    Trinity Health (10/10/25)
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