- 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
- Evolent (Columbus, OH)
- …+ Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review determinations and contacts ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are… more
- Elevance Health (Mason, OH)
- …+ Travels to worksite and other locations as necessary + BA/BS preferred + Medical claims review with prior health care fraud audit/investigation experience ... you will make an impact:** + Investigates potential fraud and over-utilization by performing medical reviews via prepayment claims review and post payment… more
- CVS Health (Columbus, OH)
- …in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, ... Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members.… more
- Elevance Health (Mason, OH)
- … medical necessity. + Extrapolates and summarizes medical information for medical director, consultants and other external review . + Research to determine ... to apply for denied services. + Utilizes guidelines and review tools to assess, analyze, interpret the medical...+ 3 years of clinical experience as a Registered Nurse is strongly preferred. + Experience reviewing medical… more
- Sedgwick (Columbus, OH)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Nurse Allocator- RN Medicare Compliance **Prior Medicare-set-aside (MSA) experience highly ... **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, specialized document review , and analysis and interpretation of interventions for the preparation of… more
- CVS Health (Columbus, OH)
- …+ 3+ years clinical nursing experience, with 1-3 years managed care experience in Utilization Review , Medical Claims Review , or other specific program ... weekends depending on business needs** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in… more
- Elevance Health (Cincinnati, OH)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope… more
- Sedgwick (Dublin, OH)
- …Representative **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
- Molina Healthcare (OH)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...for clinical member services review assessment processes. Responsible for verifying that services are… more
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