- Molina Healthcare (Detroit, MI)
- JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring ... hospital setting, including at least 1 year of utilization review , medical claims review...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Warren, MI)
- …work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and ... Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in … more
- Cognizant (Lansing, MI)
- …role expectations. **What you need to have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...the medical necessity determinations to the Health Plan/ Medical Director based on the review of… more
- CVS Health (Coldwater, MI)
- …are not permitted. **Required Qualifications** + 3+ years clinical practical experience as an Registered Nurse ( RN ) + Candidate must have active and ... all case management activities with members to evaluate the medical needs of the member to facilitate the member's...unrestricted Michigan Registered Nurse ( RN ) licensure +… more
- CVS Health (Lansing, MI)
- …Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS...setting. + A Registered Nurse that holds an active, unrestricted… more
- Elevance Health (Dearborn, MI)
- …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...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
- Elevance Health (Dearborn, MI)
- …and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a ... experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing… more
- Sedgwick (Grand Rapids, MI)
- … review of referred claims ; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. ... + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made on claims .… more
- Sedgwick (Lansing, MI)
- …Best Workplaces in Financial Services & Insurance Nurse Allocator- RN Medicare Compliance **Prior medical -set-aside experience highly desired for this ... **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, specialized document review , and analysis and interpretation of interventions for the preparation of… more
- Elevance Health (Dearborn, MI)
- …Give referral and/or make referral appointment as circumstances warrant. + Review for medical appropriateness psychiatric/substance abuse cases utilizing ... practice that is relevant to the clinical area under review . + Provide reviews for predetermination of medical...+ Conduct business in a professional manner. + Troubleshoot claims issues. + Investigate and research to resolve customer… more