- Molina Healthcare (Detroit, MI)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review … more
- Sedgwick (Grand Rapids, MI)
- … review of referred claims ; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. ... + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations...change the duties of the position at any time. \# nurse Sedgwick is an Equal Opportunity Employer and a… more
- Molina Healthcare (MI)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- Molina Healthcare (Ann Arbor, MI)
- … claims with corresponding medical records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines, and provider ... policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or… more
- Centene Corporation (Lansing, MI)
- …equivalent work experience within a managed care environment related to HEDIS record review , quality improvement, medical coding or transferable skill sets that ... performance in areas of Quality, Risk Adjustment and Operations ( claims and encounters). + Assists in delivering provider specific...Experience: Required: 1+ year of experience in related HEDIS medical record review or quality improvement with… 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 ... comprehensive support to our legal and compliance teams + Draft, review and revise legal documents and internal policies + Manage the contract review process,… more
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