• Medical Claim Review…

    Molina Healthcare (Phoenix, AZ)
    …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... schedule) Looking for a RN with experience with appeals, claims review , and medical coding....clinical/ medical reviews of retrospective medical claim reviews, medical claims and… more
    Molina Healthcare (09/06/25)
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  • Case Manager, Registered Nurse - Fully…

    CVS Health (Phoenix, AZ)
    …within time zone of residence.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, ... Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members.… more
    CVS Health (08/15/25)
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  • UM Behavioral Health Nurse

    Humana (Phoenix, AZ)
    …action. + Complete medical record reviews + Assess discharge plans + Review and extract information from claims + Complete documentation for Quality Reviews ... the appropriate courses of action. The Utilization Management Behavioral Health Nurse 2 completes medical record reviews from medical records sent from… more
    Humana (09/09/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Chandler, AZ)
    …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
    Molina Healthcare (08/15/25)
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  • Transition of Care, Licensed Vocational…

    CVS Health (Phoenix, AZ)
    …frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management ... transitions. **REQUIRED QUALIFICATIONS** - 2 years Nursing experience - Licensed Vocational Nurse in the state of California - Demonstrated knowledge and experience… more
    CVS Health (09/10/25)
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  • Sr VP Medical Director (Hourly)

    Sedgwick (Phoenix, AZ)
    …review process including making a recommendation of specialty for the Independent Medical Review process. + Developing and delivering training materials and ... Best Workplaces in Financial Services & Insurance Sr VP Medical Director (Hourly) The ideal candidate would work 8-20...the following: + Conducting reviews on cases where the nurse is seeking treatment plan clarification, claim … more
    Sedgwick (08/22/25)
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  • Workers Compensation Manager

    U-Haul (Phoenix, AZ)
    …relationships with TPAs, excess carriers, brokers and internal stakeholders to ensure claim efficiency. + Review and approve vendor invoices and third-party ... are handled in accordance with state laws and company claim standards. This position involves the supervision of staff...We're Looking For: + In-depth knowledge of WC laws, claims handling, and medical /litigation processes, with experience… more
    U-Haul (08/23/25)
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  • Customer Service Representative

    CVS Health (Phoenix, AZ)
    …issues. -Explains member's rights and responsibilities in accordance with contract. -Processes claim referrals, new claim handoffs, nurse reviews, complaints ... in preparation of complaint trend reports. -Assists in compiling claim data for customer audits. -Determines medical ...requests for appeals and pre-authorizations not handled by Clinical Claim Management. -Performs review of member … more
    CVS Health (09/10/25)
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  • Care Manager (RN)

    Centene Corporation (Phoenix, AZ)
    …to ensure all materials are gathered for financial processing + Analyze and review transplant contract and claims and liaison with transplant contractor for ... dollar cases + Coordinate transplant requests from pre-approval to claims payment processes and assist with approved transplant center...approval and claim pricing + Maintain transplant and catastrophic case logs… more
    Centene Corporation (09/12/25)
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  • Medical Director (Marketplace)

    Molina Healthcare (Phoenix, AZ)
    …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
    Molina Healthcare (08/08/25)
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