- Molina Healthcare (Fort Worth, 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 (Fort Worth, 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
- Baylor Scott & White Health (Dallas, TX)
- …of lost wages for payroll and for all approvals of medical bills per claim file. + Pay and process claims within designated authority level. + Performs other ... and/or level **Job Summary** + Under the Safe Choice Claims Manager, the Safe Choice Claims Specialist...Establish reserve requirements. Identify subrogation potential. Maintain diary. + Review and evaluate medical and lost wages.… more
- Molina Healthcare (Fort Worth, 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
- Elevance Health (Grand Prairie, TX)
- …and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU**...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
- Travelers Insurance Company (Richardson, TX)
- …Utilizes evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... negotiating and resolving assigned General Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim … more
- Elevance Health (Grand Prairie, TX)
- **Telephonic RN Nurse Case Manager I** **Sign On Bonus: $3000** **Location: This role enables associates to work virtually full-time, with the exception of required ... in different states; therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager I** is responsible for performing care management within… more
- Elevance Health (Grand Prairie, TX)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more
- Sedgwick (Irving, TX)
- …professional needs. **PRIMARY PURPOSE** : Provides disability case management and routine claim determinations based on medical documentation and the applicable ... system. + Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims . + Evaluates and arranges appropriate… more
- Veterans Affairs, Veterans Health Administration (Fort Worth, TX)
- Summary A full-time, permanent position is available for Medical Director of the Fort Worth Mental Health Clinic in the VA North Texas Health Care System Mental ... mood disorders, and homelessness. Clinical training programs exist for medical students, psychiatry residents and fellows, clinical psychologists, social workers… more
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