• 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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  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Cincinnati, OH)
    …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 (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 (Medicare)

    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 (02/09/25)
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  • Medical Director Specialty Medical

    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 (02/07/25)
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  • Case Manager RN- Field (Hamilton, Butler, Warren…

    CVS Health (Cincinnati, 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 (01/15/25)
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  • Utilization Management Representative II

    Elevance Health (Cincinnati, OH)
    …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. + ... more
    Elevance Health (01/25/25)
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