- Molina Healthcare (Davenport, IA)
- …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 (Davenport, IA)
- … 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 (Davenport, IA)
- …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 (Davenport, IA)
- …the risk management plan/program on a day-to-day basis adverse event review , investigation, and escalation. Facilitate Code Events, Apparent Cause Analysis (ACA) ... customers. The Risk Specialist collaborates extensively with local leadership (President, Chief Medical Officer (CMO), Quality and Safety Medical Officer, Chief… more