- Molina Healthcare (IA)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...nursing experience, including at least 1 year of utilization review , medical claims review… more
- Humana (Des Moines, IA)
- …interpretation and independent determination of the appropriate courses of action. The Nurse Auditor 2 validates and interprets medical documentation to ensure ... caring community and help us put health first** The Nurse Auditor 2 performs clinical audit/validation processes to ensure...clinical and coding experience to conduct a clinical validation review of the inpatient medical record to… more
- Humana (Des Moines, IA)
- …guidance where needed. Follows established guidelines/procedures. **KEY ACCOUNTABILITIES** + Review medical documentation, obtain additional information that may ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals...TRICARE, all HGB policies and procedures as well as medical necessity review criteria and privacy requirements… more
- Access Dubuque (Dubuque, IA)
- …solution-focused. **PRIMARY PURPOSE** : Provides disability case management and routine claim determinations based on medical documentation and the applicable ... your 2+ years' experience in a office setting or medical experience and grow with us! + A stable...system. + Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims . + Evaluates and… more
- Sedgwick (Dubuque, IA)
- …solution-focused. **PRIMARY PURPOSE** : Provides disability case management and routine claim determinations based on medical documentation and the applicable ... your 2+ years' experience in a office setting or medical experience and grow with us! + A stable...system. + Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims . + Evaluates and… more
- Highmark Health (Des Moines, IA)
- … review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate level of payment and ... rejection and the proper action to complete the retrospective claim review with the goal of proper...in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or… more
- Molina Healthcare (IA)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...for clinical member services review assessment processes. Responsible for verifying that services are… more
- CVS Health (Des Moines, IA)
- …+ 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 (Iowa City, IA)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review … more
- Elevance Health (West Des Moines, IA)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. + ... make an impact:** + Managing incoming calls or incoming post services claims work. + Determines contract and benefit eligibility; provides authorization for… more