- Molina Healthcare (Kenosha, WI)
- …+ Reviews medically appropriate clinical guidelines and other appropriate criteria with Chief Medical Officer on denial decisions. + Resolves escalated ... of care issues. + Prepares and presents cases in conjunction with the Chief Medical Officer for Administrative Law Judge pre-hearings, State Insurance… more
- Surgery Care Affiliates (Lake Villa, IL)
- …experienced and dynamic individual to serve as both the Chief Executive Officer (CEO) and Director of Nursing (DON) for a state-of-the-art surgery center. ... leadership and strategic management responsibilities with oversight of clinical nursing operations to ensure optimal patient care, financial performance, and… more
- Molina Healthcare (Kenosha, WI)
- …committees as required such as Credentialing, P&T and others as directed by the Chief Medical Officer . + Evaluates authorization requests in timely support of ... nurse reviewers; reviews cases requiring concurrent review, and manages...appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency,… more