- Molina Healthcare (Dayton, OH)
- …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously ... For this position we are seeking a (RN) Registered Nurse who must be licensed for the state they...they reside This position will support Medical Review for Medicare and Marketplace request authorization. Strongly prefer candidates with… more
- CenterWell (Columbus, OH)
- …experience in working with Payer requirements, both traditional Medicare and Medicare Advantage plans, ADR requests, Denials, Appeals , TPE, RCD, RAC, ZPIC, ... to, managing and monitoring all payer requests for additional documentation (ADR), appeals and denials. Works with branch staff to gather required information and… more
- Molina Healthcare (Dayton, OH)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more
- CVS Health (Columbus, OH)
- …in accordance with contract. Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) ... to incoming correspondence and internal referrals. Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs… more
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