- Molina Healthcare (Seattle, WA)
- …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 (Seattle, WA)
- **Behavioral Health Nurse Medical Mgmt I - Washington** Location: **This position is primarily a Virtual/Remote role. Ideal candidates** **Must live within 50 ... 4:30 pm (Pacific Standard Time)** . The **Behavioral Health** ** Nurse Medical Mgmt I** is responsible to... directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied.… more
- Molina Healthcare (Seattle, WA)
- …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
- Premera Blue Cross (Mountlake Terrace, WA)
- …that we serve through our Healthsource blog: https://healthsource.premera.com/ . The ** Medical Policy (MP) Clinical Specialist** is a critical role in Premera, ... responsible for the development and maintenance of medical policies to guide coverage determinations for new and...works closely with non-clinical support staff and the clinical review department to identify and resolve any issues related… more
- Molina Healthcare (Bothell, WA)
- …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
- Elevance Health (Seattle, WA)
- …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