- Molina Healthcare (Madison, WI)
- **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
- Insight Global (Brookfield, WI)
- …the product across claims operations. * Provide expert guidance on medical management, litigation management, and complex claim handling strategies. * ... implementation for our clients. We are seeking a seasoned claims professional to serve as the claim 's...knowledge of medical cost containment strategies (bill review , utilization review , provider networks, nurse… more
- Packing Corp of America (Tomahawk, WI)
- …The Nurse must maintain relationships with internal and external customers. The Nurse is the facility's medical professional and employees rely on the ... detection. Maintains wellness boards monthly with fresh topics. + Review , update, and maintain essential job function reports. +...Nurse to provide medical advice and treatment that is accurate, respectful of… more
- Humana (Madison, WI)
- …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
- Humana (Madison, WI)
- …guidance where needed. Follows established guidelines/procedures. **KEY ACCOUNTABILITIES** + Review medical documentation, obtain additional information that may ... community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals...TRICARE, all HGB policies and procedures as well as medical necessity review criteria and privacy requirements… more
- Highmark Health (Madison, WI)
- … 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
- Molina Healthcare (WI)
- …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 (Madison, WI)
- …+ 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
- Molina Healthcare (Racine, WI)
- …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
- Veterans Affairs, Veterans Health Administration (Green Bay, WI)
- …are determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. Pay: ... the ambulatory dermatology setting, including evaluation/consultation, examination, diagnosis, follow-up, medical record documentation/record-keeping and correspondence surgical procedures including staffing… more