• Clinical Appeal & Claim…

    Medical Mutual of Ohio (OH)
    …workplace and perform pre-employment substance abuse and nicotine testing._ **Title:** _Clinical Appeal & Claim Review Nurse II_ **Location:** _Ohio_ ... + Independently evaluates basic to complex medical claims and/or appeal cases and associated records by applying clinical , regulatory, and… more
    Medical Mutual of Ohio (05/14/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (OH)
    …of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and...specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long… more
    Molina Healthcare (05/16/25)
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  • Grievance/Appeals Analyst I

    Elevance Health (Mason, OH)
    …and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or ... summarize and route to nursing and/or medical staff for review . + The grievance and appeal work...+ Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical… more
    Elevance Health (05/14/25)
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  • Appeals Licensed Practical Nurse

    Evolent (Columbus, OH)
    …interact with coordinators who set up the appeal , physicians and other clinicians who review the appeal , the claims department to review provider ... adjudication of processed appeals. **What You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review as an LPN or LVN… more
    Evolent (05/16/25)
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  • Coordinator, Utilization Management

    Evolent (Columbus, OH)
    …request. + Submitting IT tickets to address barriers to generating cases for clinical review and following the ticket through to completion. + Addressing ... our daily operations this individual also works with our clinical team, which includes our medical reviews: LVNs, LPNs,...prior authorization requests and/or relevant health care experience in claims or appeal & grievances is required.… more
    Evolent (05/03/25)
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