- 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
- CVS Health (Dearborn, MI)
- …+ Conducts assessments that consider information from various sources, such as claims , to address all conditions including co-morbid and multiple diagnoses that ... Qualifications** + Minimum 3+ years clinical practical experience as an Registered Nurse (RN). + Must have active and unrestricted Michigan RN licensure. +… 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 all ... claims to ensure information substantiates disability. + Provides clear...change the duties of the position at any time. \# nurse #casemanagementspecialist Sedgwick is an Equal Opportunity Employer 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 ... the claim. + Maintains communication with the customer, Client Service Director, and Claims Examiner providing timely updates on changes in injured worker status and… more
- Elevance Health (Dearborn, MI)
- …and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes and audits claims ... recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a minimum of… more
- R1 RCM (Detroit, MI)
- …AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to draft ... appeals of denied and underpaid claims . Every day you will review medical records to...you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal… more
- CVS Health (Lansing, MI)
- …Provide excellent customer services for high volume inbound provider calls for the Claims Inquiry/ Claims Research Medicaid team. Extensive claims research on ... in accordance with contract. + Process claim referrals, new claim handoffs, nurse reviews, provider complaints, grievance and appeals via target system. + Assists… more
- Otsuka America Pharmaceutical Inc. (Lansing, MI)
- …backgrounds (eg licensed therapists, clinical psychologists, behavioral health specialists, Nurse Practitioners and Physician Assistants in behavioral health, etc.) ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… more