- Molina Healthcare (Grand Rapids, MI)
- For this position we are seeking a ( RN ) Registered Nurse who...for a RN with experience with appeals, claims review , and medical coding. ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… more
- Cognizant (Lansing, MI)
- …expectations. **What you need to have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...the medical necessity determinations to the Health Plan/ Medical Director based on the review of… more
- CVS Health (Detroit, MI)
- …conversation. **Required Qualifications** + Minimum 3+ years clinical practical experience as a Registered Nurse + Must have active and unrestricted Michigan ... heart, each and every day. **Position Summary** **Case Manager RN ** WFH Flexible This role will be 25-50%% travel...Registered Nurse licensure + Must be willing and able to… more
- CVS Health (Lansing, MI)
- …not permitted. **Required Qualifications** + Minimum 3+ years clinical practical experience as an Registered Nurse ( RN ). + Must have active and unrestricted ... 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 (Kalamazoo, MI)
- …status and health needs based on key questions and conversation. **Required Qualifications** - Registered Nurse with active MI state license in good standing ... all with heart, each and every day. **Case Manager RN ** WFH/Field **Position Summary** Help us elevate our patient...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… 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...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
- CVS Health (Lansing, MI)
- …however, it is subject to change based on business needs.** The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating ... all case management activities with members to evaluate the medical needs of the member and to help facilitate...- Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit… more
- Molina Healthcare (MI)
- …managed care experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports ... likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Ann Arbor, MI)
- …Microsoft Excel (edit/save spreadsheets, sort/filter) **Required License, Certification, Association** Licensed registered nurse ( RN ), Licensed practical ... internal policies, and contract requirements. This position completes a medical review to facilitate a referral to...corresponding medical records to determine accuracy of claims payments. + Review of applicable policies,… more
- Sedgwick (Lansing, MI)
- …providers to support the claim request and documents decision rationale. + Completes medical review of all claims by reviewing medical documentation ... clinical evaluations on claims that require additional review based on medical condition, client requirement,... management of claims including comprehension of medical terminology and substantiating claim decisions. **ADDITIONAL… more