- Molina Healthcare (Covington, KY)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...Claims Auditing, Medical Necessity Review and Coding experience +… more
- Elevance Health (Cincinnati, OH)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,… more
- Elevance Health (Cincinnati, OH)
- **Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more
- Molina Healthcare (Covington, KY)
- … claims with corresponding medical records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines, and provider ... policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or… more
- Molina Healthcare (Covington, KY)
- …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
- CVS Health (Amelia, OH)
- …holidays, and flexibility as you coordinate the care of your members. + Nurse Case Manager is responsible for telephonically and/or face to face assessing, planning, ... all case management activities with members to evaluate the medical needs of the member to facilitate the member's...+ Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit… more
- Veterans Affairs, Veterans Health Administration (Cincinnati, OH)
- Summary The Cincinnati VA Medical Center (VAMC) is searching for a full-time academic Heart Failure Cardiologist to fulfill the current staffing needs of our ... as well as working in conjunction with the Heart Failure RN and nurse practitioner. The multidisciplinary team assists with requests for left ventricular assist… more