• Medical Claim Review

    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 ... more
    Molina Healthcare (01/25/25)
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  • Nurse /CPC - Clinical Fraud Investigator…

    Elevance Health (Mason, OH)
    ** Nurse /CPC - Clinical Fraud Investigator Senior - SIU Fraud...control. + Review and conducts analysis of claims and medical records prior to payment. + ... more
    Elevance Health (02/13/25)
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  • Clinical Appeals Nurse (RN): Texas and New…

    Molina Healthcare (Covington, 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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  • Medical Director (Marketplace)

    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 ... more
    Molina Healthcare (02/06/25)
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  • Case Manager RN- Field (Hamilton, Butler, Warren…

    CVS Health (Norwood, 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, ... more
    CVS Health (01/16/25)
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