- Molina Healthcare (Ann Arbor, MI)
- …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
- Molina Healthcare (Ann Arbor, MI)
- …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
- Molina Healthcare (Ann Arbor, MI)
- …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
- Trinity Health (Livonia, MI)
- …and equipment for unit function. + May be responsible for assuring that patient medical claim data used for billing purposes accurately reflects the clinical ... Health Livonia continues to offer the latest in quality health and medical services. Trinity Health Livonia has received numerous awards recognizing excellence in… more