- Sedgwick (Lansing, MI)
- …cases accordingly. + Interviews practitioners involved in medical malpractice claims . + Participates in follow-up review and investigation as directed ... Professional Liability **PRIMARY PURPOSE OF THE ROLE:** Investigate, analyze and evaluate medical malpractice claims to assess liability issues and exposure.… more
- Sedgwick (Lansing, MI)
- …and assessment with service provider. + Calls treating physicians to conduct a peer review of medications used on specific claims and provides insight for drug ... in drug selection and dosage, and monitor complex drug regimens; to provide medical necessity reviews to evaluate, implement, and monitor options and services to… more
- Sedgwick (Detroit, 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 are made on claims .… more
- 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 ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… 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 and ... Coding Appeals Nurse ** , you will help review and interpret medical records to draft...and underpaid claims . Every day you will review medical records to ensure appropriate coding… more
- Elevance Health (Dearborn, MI)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,… more
- Public Consulting Group (Lansing, MI)
- …and on a team. + Proven working experience in case management, including as a nurse , medical , mental health care manager or a related job + Excellent knowledge ... Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + Cost… 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
- CVS Health (Kalamazoo, MI)
- …implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. + ... 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