- CVS Health (Lansing, MI)
- …members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and eligibility status. ... and support safe transitions. **REQUIRED EXPERIENCE** - 2 years Licensed Vocational Nurse (LVN) nursing experience - Active and unrestricted State of Michigan LVN… more
- Molina Healthcare (Detroit, MI)
- …including hospital acute care/ medical experience (STRONGLY DESIRED)** + **Registered Nurse with Claims and CIC coding experience (STRONGLY DESIRED)** + ... **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...scope of a Payment Integrity Clinician. This includes assessing medical documentation, itemized bills, and claims data… more
- Travelers Insurance Company (Detroit, MI)
- …internal and/or external resources for specific activities required to effectively evaluate claims , such as Subrogation, Risk Control, nurse consultants, and ... resolving assigned Specialty Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim life cycle (customer… more
- Corewell Health (Farmington Hills, MI)
- …of patient related injuries and manage the resolution of pre-notice claims . Essential Functions + Reviews and provides recommendations regarding the development ... management strategies. + Manages patient incidents and administers professional liability claims in collaboration with management. Participates in evaluations of … more
- Sedgwick (Detroit, MI)
- …work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and completes medical review of ... disability. + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made… more
- Molina Healthcare (Grand Rapids, MI)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and… more
- Sedgwick (Lansing, MI)
- …Work(R) Fortune Best Workplaces in Financial Services & Insurance RN Crisis Care Triage **This nurse will need to be on call every Saturday 6am until Monday 6am each ... injury referral calls from clients; gathers vital case details, obtains and provides medical status updates to the customer, and assigns a Field Case Manager (FCM)… more
- Elevance Health (Dearborn, MI)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... claims . **How you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in… more
- R1 RCM (Detroit, MI)
- …working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid claims . + Apply clinical judgment ... Nurse ** , you will help review and interpret medical records to draft appeals of denied and underpaid claims . Every day you will review medical records… more
- Sedgwick (Lansing, MI)
- …PURPOSE OF THE ROLE:** While partnering with the injured worker, employer, and medical providers, create a case management strategy to facilitate medical ... and a successful return to work through advocacy, communication and coordination of medical services. **ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic… more