- 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
- Sedgwick (Grand Rapids, 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
- 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
- Elevance Health (Dearborn, MI)
- …Give referral and/or make referral appointment as circumstances warrant. + Review for medical appropriateness psychiatric/substance abuse cases utilizing ... practice that is relevant to the clinical area under review . + Provide reviews for predetermination of medical...+ Conduct business in a professional manner. + Troubleshoot claims issues. + Investigate and research to resolve customer… 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
- Sedgwick (Grand Rapids, MI)
- …the ADA process for claimants requesting accommodations under the ADAAA; to review complex medical information for temporary and permanent accommodation ... and/or client requirements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Reviews medical information for ADAAA temporary and permanent accommodation requests. +… more
- CVS Health (Lansing, MI)
- …+ 3+ years of clinical experience in a healthcare setting. + 2+ years as a Registered Nurse ( RN ) or License Practical Nurse / License Vocational ... Nurse . + Active, current, and unrestricted RN /LVP/LPN license in the state of residence. + Proficiency in Microsoft Office Suite (Outlook, Excel) and ability to… more
- Intermountain Health (Lansing, MI)
- …and collaborates with Clinical Documentation Integrity (CDI) Registered Nurses ( RN ) and Intermountain Physician Advisors to review complex facility ... Diseases ICD-10 and Diagnosis Related Groups (DRG) codes for claims concurrently while a patient is in a hospital....reviews while patients are hospitalized. It aids in the review of quality measures including Patient Safety Indicators and… more