- Molina Healthcare (Salt Lake City, UT)
- …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
- CVS Health (Salt Lake City, UT)
- …within time zone of residence.** 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
- Humana (Salt Lake City, UT)
- …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 (UT)
- …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
- Sedgwick (Salt Lake City, UT)
- …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
- Insight Global (South Jordan, UT)
- …with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement ... payment systems. This position is responsible for auditing inpatient medical records and generating high-quality recoverable claims ...(2 years in clinical documentation) OR IF NOT A NURSE : Degree in RHIM, RHIA, RHIT with medical… more
- Molina Healthcare (Layton, UT)
- …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 (West Valley City, UT)
- …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
- Veterans Affairs, Veterans Health Administration (Ogden, UT)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... quality improvement initiatives and will attend the Psychiatry Service, Prescriber Peer Review , and other meetings as appropriate. Uses advanced clinical judgment to… more
- CVS Health (Salt Lake City, UT)
- …Plans -Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most ... Care Management Associate you will be supporting comprehensive coordination of medical services including Care Team intake, screening and supporting the… more