• Medical Claim Review…

    Molina Healthcare (Las Cruces, NM)
    …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 (09/06/25)
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  • Nurse (Case Management) - ESEP/MP

    Indian Health Service (Dulce, NM)
    …may be required to obtain approval and be able to coordinate denied claims for resubmission through appeals with additional medical or supporting information. ... care teams, external entities, and PRC. This position reports to the Chief Nurse Executive. Area Nurse Recruiter: Olinka Foster (Albuquerque) Phone: ### or… more
    Indian Health Service (08/16/25)
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  • UM Behavioral Health Nurse

    Humana (Santa Fe, NM)
    …action. + Complete medical record reviews + Assess discharge plans + Review and extract information from claims + Complete documentation for Quality Reviews ... the appropriate courses of action. The Utilization Management Behavioral Health Nurse 2 completes medical record reviews from medical records sent from… more
    Humana (09/09/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Las Cruces, NM)
    …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
    Molina Healthcare (08/15/25)
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  • Sr VP Medical Director (Hourly)

    Sedgwick (Santa Fe, NM)
    …review process including making a recommendation of specialty for the Independent Medical Review process. + Developing and delivering training materials and ... Best Workplaces in Financial Services & Insurance Sr VP Medical Director (Hourly) The ideal candidate would work 8-20...the following: + Conducting reviews on cases where the nurse is seeking treatment plan clarification, claim … more
    Sedgwick (08/22/25)
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  • Medical Director (Marketplace)

    Molina Healthcare (Santa Fe, NM)
    …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
    Molina Healthcare (08/08/25)
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  • Clinical Audit and Appeals Consultant

    Intermountain Health (Santa Fe, NM)
    …and appeal activity to stakeholders throughout the denial process up to and including medical review boards and in the court of law. **Essential Functions** + ... a registered nurse required. + Experience in Microsoft office, electronic medical record systems and electronic databases + Demonstrates in depth knowledge of… more
    Intermountain Health (09/08/25)
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  • Director of Risk Management

    Community Health Systems (Las Cruces, NM)
    …incident reporting, and corrective actions to mitigate risk. + Manages claims and litigation processes, coordinating with legal counsel and maintaining detailed ... regarding real and potential risk issues. + Ensures accurate management and review of occurrence reporting systems, analyzing data to identify trends and implement… more
    Community Health Systems (09/09/25)
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