- Molina Healthcare (Grand Rapids, MI)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... **Job Duties** + Performs clinical/ medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which… more
- Henry Ford Health System (Troy, MI)
- …with department standards regarding productivity and audit quality. CERTIFICATIONS/LICENSURES REQUIRED: Registered Nurse credentialed from the Michigan Board of ... + Bachelor's in nursing (BSN) preferred. + Experience in medical record review , billing and coding accuracy...accessing portals when needed. + Conducts concurrent and retrospective claim audits to assure adherence to CMS and other… more
- Public Consulting Group (Lansing, MI)
- …sector. To learn more, visit www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case Manager ... Proven working experience in case management, including as a nurse , medical , mental health care manager or...plans. + Current license, certification or registration as a Registered Nurse or Social Worker **Working Conditions**… more
- CVS Health (Lansing, MI)
- …+ Minimum 3+ years clinical practical experience. + Must have active and unrestricted Registered Nurse licensure in the state of MI + Must be willing ... all case management activities with members to evaluate the medical needs of the member to facilitate the member's...member's overall wellness. + Uses clinical tools and information/data review to conduct an evaluation of member's needs and… more
- Molina Healthcare (MI)
- …to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. ... nursing experience with broad clinical knowledge. + Five years experience conducting medical review and coding/billing audits involving professional and facility… more
- Molina Healthcare (Grand Rapids, MI)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of… more
- Guardian Life (Lansing, MI)
- …providing comprehensive medical reviews and analysis of long-term disability claims . The RN Clinical Consultant identifies restrictions, limitations and ... duration impacting functional capacity based on medical data, to assist the Claim Managers...The RN Clinical Consultant reviews long-term disability claims to determine the impact of claimants' medical… more
- CVS Health (Lansing, MI)
- …status and health needs based on key questions and conversation. **Required Qualifications** - Registered Nurse with active MI state license in good standing ... all with heart, each and every day. **Case Manager RN ** WFH Flexible **Position Summary** Help us elevate our...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- R1 RCM (Detroit, MI)
- …working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid claims . + Apply clinical judgment and ... and underpaid claims . Every day you will review medical records to ensure appropriate coding...external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + An active CCS,… more
- Lincoln Financial (Lansing, MI)
- …as indicated **What we're looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where the ... organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you… more
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