- OhioHealth (Columbus, OH)
- …The position requires a diverse set of organizational skills, medical chart review and analysis, knowledge of claims appeal process and ability to apply ... (Interqual, Milliman) practice management guidelines to determine medical necessity and appropriateness of coding and billing. Must...for RAC audits and appeals in response to a claims denial from the RAC. He/She works collaboratively with… more
- Sedgwick (Columbus, OH)
- …**PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, specialized document review , and analysis and interpretation of interventions for the preparation of ... and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or...to the next round, recruiter will be in touch. \# nurse #medicare #medicaresetaside _As required by law, Sedgwick provides… more
- CVS Health (Columbus, OH)
- …plans. Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most ... a caseload. The Care Management Associate supports comprehensive coordination of medical services including Care Team intake, screening and supporting the… more
- Elevance Health (Mason, OH)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... I** will be responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing incoming calls or… more
- Elevance Health (Cincinnati, OH)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. + ... are not limited to: Managing incoming calls or incoming post services claims work. + Determines contract and benefit eligibility; provides authorization for… more