• Care Review Clinician , Applied…

    Molina Healthcare (Omaha, NE)
    **Job Description** **Job Summary** Provides support for member clinical review processes specific to applied behavioral analysis (ABA) services. Responsible for ... quality and cost-effective member care. **Knowledge/Skills/Abilities** * Assesses applied behavioral analysis (ABA) services for members - ensuring optimum outcomes,… more
    Molina Healthcare (11/06/25)
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  • Care Review Clinician , PA (RN)

    Molina Healthcare (Bellevue, NE)
    …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS… more
    Molina Healthcare (10/26/25)
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  • Payment Integrity Clinician

    Highmark Health (Lincoln, NE)
    …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
    Highmark Health (11/14/25)
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