• Medical Claim Review

    Molina Healthcare (Detroit, MI)
    …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 (Dearborn, MI)
    ** 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 (Detroit, MI)
    …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 (Medicare)

    Molina Healthcare (Detroit, MI)
    …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 (Marketplace)

    Molina Healthcare (Detroit, MI)
    …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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  • Clinical Coding Appeals Supervisor

    R1 RCM (Detroit, MI)
    …prior leadership experience in medical record reviews and extensive knowledge of medical coding for inpatient and outpatient claims , as well as reimbursement ... more
    R1 RCM (02/15/25)
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  • Patient Care Tech Step Down Unit

    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 ... more
    Trinity Health (12/28/24)
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