- Molina Healthcare (TX)
- …(Team will work on set schedule) Looking for a RN with experience with appeals , claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support ... for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical … more
- Elevance Health (Grand Prairie, TX)
- …case reviews with attending physicians or other ordering providers to discuss review determinations. + Interprets existing policies or clinical guidelines and ... The **Plan Performance Medical Director** serves as a lead clinician and oversees the administration of medical services for...or territory of the United States when conducting utilization review or an appeals consideration and cannot… more