- Medical Mutual of Ohio (OH)
- …(Medicare) compliance, regulatory audits and process improvement. **Professional Certification(s):** . Registered Nurse with current State of Ohio unrestricted ... Founded in 1934, Medical Mutual is the oldest and one of...management and MA Compliance via presentations and Dashboard. Ensures audit ready preparedness for both annual and ad-hoc audits… more
- Sedgwick (Columbus, OH)
- …accredited college or university preferred. Current Certified Rehabilitation Counselor (CRC) or Registered Nurse ( RN ) license required. Current license, ... clinical evaluations on claims that require additional review based on medical condition, client requirement, and/or complexity. Consults with providers and… more
- Elevance Health (Mason, OH)
- …background. **Preferred Skills, Capabilities, and Experiences:** + Coding Certificate or Registered Nurse preferred. + Law Enforcement investigation of ... control. + Review and conducts analysis of claims and medical records prior to payment. + Researches new healthcare...regarding approved interventions such as recovery of overpayment, pre-payment audit of claims or putting providers on notice. +… more
- Premier Health (Dayton, OH)
- …patients by air ambulance or mobile intensive care to a higher level medical treatment facility. The Flight Nurse provides advanced emergency/critical care ... patients throughout Premier Health. This position also include public relations and medical education functions. Flight Nurse is accountable for compliance with… more
- Sedgwick (Dayton, OH)
- …consult providers and employees; to provide case direction; and to ensure medical information substantiates the need for absence from work. **ESSENTIAL FUNCTIONS and ... clinical review of referred claims; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. +… more