- Molina Healthcare (Provo, UT)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...nursing experience, including at least 1 year of utilization review , medical claims review… more
- Humana (Salt Lake City, UT)
- …interpretation and independent determination of the appropriate courses of action. The Nurse Auditor 2 validates and interprets medical documentation to ensure ... caring community and help us put health first** The Nurse Auditor 2 performs clinical audit/validation processes to ensure...clinical and coding experience to conduct a clinical validation review of the inpatient medical record to… more
- Highmark Health (Salt Lake City, UT)
- … review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate level of payment and ... rejection and the proper action to complete the retrospective claim review with the goal of proper...in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or… 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 (Orem, UT)
- …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
- CVS Health (Salt Lake City, UT)
- …+ Explains member's rights and responsibilities in accordance with contract. + Processes claim referrals, new claim handoffs, nurse reviews, complaints ... in preparation of complaint trend reports. Assists in compiling claim data for customer audits. + Determines medical...requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs review of member … more
- Veterans Affairs, Veterans Health Administration (Salt Lake City, UT)
- Summary The HBPC Medical Director, appointed by the Chief of Staff, must be a physician who is responsible for the overall medical care delivered by the HBPC ... team. NOTE: In facilities with academic affiliations, the HBPC Medical Director is encouraged to have a faculty appointment and be involved in academic activities.… 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 ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review … more