- Sedgwick (Lansing, MI)
- …and investigates cases accordingly. + Interviews practitioners involved in medical malpractice claims . + Participates in follow-up review and investigation as ... PURPOSE OF THE ROLE:** Investigate, analyze and evaluate medical malpractice claims to assess liability issues and exposure. Reviews medical records, interviews… more
- Sedgwick (Lansing, MI)
- …and assessment with service provider. + Calls treating physicians to conduct a peer review of medications used on specific claims and provides insight for drug ... team on difficult cases. + Consults with pharmacy UR team for difficult claims requiring weaning schedule. + Assesses needs, gives appropriate clinical options, and… more
- Sedgwick (Detroit, MI)
- …for absence from work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and completes ... medical review of all claims to ensure information substantiates disability. + Provides clear...change the duties of the position at any time. \# nurse #casemanagementspecialist Sedgwick is an Equal Opportunity Employer and… more
- R1 RCM (Detroit, MI)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical records ... to draft appeals of denied and underpaid claims . Every day you will review medical...you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records… more
- Elevance Health (Dearborn, MI)
- …clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will ... make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical… more
- Morley (Saginaw, MI)
- …family or school obligations **_What You'll Do_** + **Assist with contract review and management, legal research, policy development and compliance** + Provide ... support to our legal and compliance teams + Draft, review and revise legal documents and internal policies +...+ Teladoc: 24/7 online access to doctors + 24/7 nurse help desk + Patient advocacy: Free 24/7 help… more
- Public Consulting Group (Lansing, MI)
- …Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + Cost ... and client-centered + Handles case assignments, draft service plans, review case progress and determine case closure + Travels...Proven working experience in case management, including as a nurse , medical, mental health care manager or a related… more
- Molina Healthcare (Detroit, MI)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.… more
- CVS Health (Kalamazoo, MI)
- …to enhance a member's overall wellness. + Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits. + Applies clinical ... + Conducts assessments that consider information from various sources, such as claims , to address all conditions including co-morbid and multiple diagnoses that… more