- Molina Healthcare (Cleveland, OH)
- …experience, 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...Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as… more
- CVS Health (New Albany, OH)
- …including co-morbid and multiple diagnoses that impact functionality. - Reviews prior claims to address potential impact on current case management and eligibility. ... health needs based on key questions and conversation. **Required:** - A Registered Nurse that must hold an unrestricted license in their state of residence,… more
- Elevance Health (Mason, OH)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 days ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- Molina Healthcare (Cincinnati, OH)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases ... of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of… more
- Elevance Health (Columbus, OH)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- Elevance Health (Mason, OH)
- **Transplant Nurse II** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... Wednesday - Sunday or Thursday - Monday. The **Transplant Nurse II** will be responsible for providing case and/or...treatment plans. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- Elevance Health (Mason, OH)
- ** Nurse Case Manager II** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... an accommodation is granted as required by law._ The ** Nurse Case Manager II** will be responsible for care...as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- Travelers Insurance Company (Cleveland, OH)
- …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
- Sedgwick (Columbus, OH)
- …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 (Columbus, OH)
- …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