- Molina Healthcare (Akron, OH)
- …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
- Humana (Columbus, OH)
- …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
- Molina Healthcare (Cincinnati, OH)
- …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
- Dayton Children's Hospital (Dayton, OH)
- …acute care experience in a hospital required + 3-5 years as progressive utilization review nurse and knowledge of payers and managed care contracts preferred + ... Facility:Work From Home - OhioDepartment:Utilization Review TeamSchedule:Full timeHours:40Job Details:Reporting to the Manager of Utilization Management and in… more
- Sedgwick (Columbus, OH)
- …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 (Dublin, OH)
- …Representative Sr **PRIMARY PURPOSE** : Provides disability case management and routine claim determinations based on medical documentation and the applicable ... system. + Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims . + Evaluates and arranges appropriate… more
- Medical Mutual of Ohio (OH)
- Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million ... planning coordination and facilitation. Works with IT and Clinical Nurse staff to aid in the loading of HEDIS...in the loading of HEDIS data and collection of medical records. Works closely with HEDIS vendor support to… more
- Molina Healthcare (Akron, OH)
- …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
- Intermountain Health (Columbus, OH)
- …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
- Elevance Health (Mason, OH)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,… more
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