- Evolent (Lansing, MI)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- McLaren Health Care (Grand Blanc, MI)
- **Position Summary:** Responsible for coordinating the appeals process for third party payer denials, primarily RAC-related activities and commercial appeals ... physicians, other team members, payers, and administrators regarding denial and appeals cases reviews and process. 6. Maintains accurate complete documentation of… more
- Cognizant (Lansing, MI)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- McLaren Health Care (Mount Clemens, MI)
- …. Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews ... of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and achieve optimal payment for… more
- Molina Healthcare (Warren, MI)
- …will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing clinical knowledge and ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical peers. +… more
- Molina Healthcare (MI)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends… more
- McLaren Health Care (Grand Blanc, MI)
- …+ Associate's degree in nursing or healthcare related field **.** Current Registered Nurse license in the state of Michigan or possess a Doctor of Medicine ... **4 years of utilization management, case management, clinical documentation, and/or denials/ appeals experience in an acute healthcare facility** **.** American Case… more
- Corewell Health (Dearborn, MI)
- …when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization for care and ... care management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan Upon Hire required + Basic Life… more
- Corewell Health (Royal Oak, MI)
- …when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization for care and ... management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan License Upon Hire required How Corewell… more