- Molina Healthcare (Sterling Heights, MI)
- …a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/ appeals . + Provides training and support to clinical peers. + ... JOB DESCRIPTION **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal… more
- Molina Healthcare (Warren, MI)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides support for … more
- University of Michigan (Ann Arbor, MI)
- …care areas. The position is unique in that it combines clinical /quality considerations with regulatory/financial/utilization review demands. The position creates a ... balance between individual clinical needs with the efficient and cost effective utilization...Cycle/HIM regarding RAC decision to appeal, denials; input into appeals ; share findings with providers + Review all cases… more