- Molina Healthcare (Austin, TX)
- …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 (Austin, TX)
- …clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review . **Required License, Certification, Association** Active, ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...of proactive approaches to improve and standardize overall retrospective claims review . * Ensures core system is… more
- CVS Health (Austin, TX)
- …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 (Austin, TX)
- …and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. RN ... - Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit...and multiple diagnoses that impact functionality. - Reviews prior claims to address potential impact on current case management… more
- Humana (Austin, TX)
- …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
- Molina Healthcare (Austin, TX)
- …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
- CVS Health (Austin, TX)
- …reduce risk factors, address barriers, and resolve complex health and social issues. + Review prior claims to assess impact on current case management and ... health and wellness. This includes telephonic and/or face-to-face interactions to evaluate medical needs and develop proactive care plans that improve both short-… more
- Sedgwick (Austin, TX)
- …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
- CVS Health (Austin, TX)
- …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
- Molina Healthcare (Austin, TX)
- …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
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