- Molina Healthcare (Sterling Heights, MI)
- …At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports ... DESCRIPTION **Job Summary** Provides support for medical claim and internal appeals review activities -...or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must… more
- Molina Healthcare (Warren, 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
- 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)
- …Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS...setting. + A Registered Nurse that holds an active, unrestricted… 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 (Detroit, 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 Flexible **Position Summary** Help us elevate our...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… 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
- Highmark Health (Lansing, MI)
- …+ 1-3 years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related ... rejection and the proper action to complete the retrospective claim review with the goal of proper...Review process includes a review of medical documentation, itemized bills, and claims data… more
- Centene Corporation (Lansing, MI)
- …Licensed Marital and Family Therapist (LMFT), Licensed Certified Social Worker (LCSW), Licensed Registered Nurse ( RN ), Acute Care Nurse Practitioner ... equivalent work experience within a managed care environment related to HEDIS record review , quality improvement, medical coding or transferable skill sets that… 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. Develops ... 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