• Medical Claim Review

    Molina Healthcare (Louisville, KY)
    …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... more
    Molina Healthcare (01/25/25)
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  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Louisville, KY)
    …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... more
    Elevance Health (01/01/25)
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  • Clinical Appeals Nurse (RN): Texas and New…

    Molina Healthcare (Louisville, KY)
    …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... more
    Molina Healthcare (02/09/25)
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  • Nurse /CPC - Clinical Fraud Investigator II…

    Elevance Health (Louisville, KY)
    ** Nurse /CPC - Clinical Fraud Investigator II - SIU...control. + Review and conducts analysis of claims and medical records prior to payment. ... more
    Elevance Health (02/08/25)
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  • Medical Director (Medicare)

    Molina Healthcare (Louisville, KY)
    …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... more
    Molina Healthcare (02/09/25)
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  • Medical Director Specialty Medical

    Molina Healthcare (Louisville, KY)
    …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... more
    Molina Healthcare (02/07/25)
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