- 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)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… 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