- Lincoln Financial (Columbus, OH)
- …at a Glance** We are excited to bring on highly motivated Short Term Disability Claims Specialists to staff our ever-growing claims organization. As a Short Term ... home, then please read on! Click the following link Claims Specialist Job Preview (https://marketingmedia.lfg.com/lfg/DOCS/lfd/emailMarketing/Video/6369162297112.html) to see a realistic… more
- Sedgwick (Columbus, OH)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and colleague technical ... line of business experience in telephonic case management (TCM) and/or utilization review or equivalent combination of education and experience required. **Skills &… more
- CVS Health (New Albany, OH)
- …through integration. - Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit plan eligibility and ... and multiple diagnoses that impact functionality. - Reviews prior claims to address potential impact on current case management...on key questions and conversation. **Required:** - A Registered Nurse that must hold an unrestricted license in their… more
- Elevance Health (Mason, OH)
- …guidelines and to identify opportunities for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU**...Skills, Qualifications, and Experiences:** + Fraud and Abuse experienced Nurse with a CPC are highly desired. For candidates… more
- Molina Healthcare (Cincinnati, OH)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
- Elevance Health (Columbus, OH)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- Molina Healthcare (Cleveland, OH)
- …experience, including hospital acute care/medical experience (STRONGLY DESIRED)** + **Registered Nurse with Claims and CIC coding experience (STRONGLY DESIRED)** ... **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as… more
- Sedgwick (Columbus, OH)
- …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 (Columbus, OH)
- …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 (Columbus, OH)
- …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