- Lincoln Financial (Lansing, MI)
- …at a Glance** We are excited to bring on highly motivated Short Term Disability Claims Specialists to staff our ever-growing claims organization. As a Short Term ... conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You'll… more
- Sedgwick (Lansing, MI)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and colleague technical ... line of business experience in telephonic case management (TCM) and/or utilization review or equivalent combination of education and experience required. **Skills &… more
- Veterans Affairs, Veterans Health Administration (Ann Arbor, MI)
- …S. Kettles VA Medical Center is seeking a Full-Time Registered Nurse (RN) - Clinical Risk Manager Program Manager aligned under Patient Safety. Responsibilities ... audience in useable information formats. Manages databases for Peer Review , Occurrence screens and Torts including entering data and...the event of an adverse event Processes small tort claims for the facility and acts as a liaison… more
- Molina Healthcare (Ann Arbor, MI)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
- Elevance Health (Dearborn, MI)
- …and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU**...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
- CVS Health (Warren, MI)
- …And we do it all with heart, each and every day. **Case Manager Registered Nurse ** WFH Flexible This role will be 25-50%% travel within **Wayne or Macomb Countie** ... all case management activities with members to evaluate the medical needs of the member to facilitate the member's...member's overall wellness. + Uses clinical tools and information/data review to conduct an evaluation of member's needs and… more
- CVS Health (Lansing, MI)
- …and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. **Position ... to enhance a member's overall wellness. + Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits. + Applies clinical… more
- CVS Health (Dearborn, MI)
- …and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. Join ... to enhance a member's overall wellness. + Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits. + Applies clinical… more
- CVS Health (Lansing, MI)
- …frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management ... 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