- Elevance Health (Mason, OH)
- …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
- Public Consulting Group (Columbus, OH)
- …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 (Cincinnati, OH)
- …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 (New Albany, OH)
- …(1-2 times per quarter).** Typical training hours are Monday-Friday 8-4:30 EST. Nurse Care Manager is responsible for telephonically and/or face to face assessing, ... + Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit...and multiple diagnoses that impact functionality. + Reviews prior claims to address potential impact on current case management… more
- CVS Health (Columbus, OH)
- …to accommodate business needs. Position Responsibilities: + Responsible for initial review and triage of members. + Manages population health member enrollment ... for health care service delivery under the direction of nurse or medical director in the most appropriate setting...+ May assist in the research and resolution of claims payment issues. Supports the administration of the hospital… more