- Molina Healthcare (Dallas, TX)
- …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
- Travelers Insurance Company (Richardson, TX)
- …case resolution. + Review , approve and issue accurate and timely indemnity, medical and expense payments for lifetime/long-term claims . + Determine Value of ... 1 **What Is the Opportunity?** Under moderate supervision, manage Workers' Compensation Claims with: Stable Lifetime Indemnity and/or Medical Benefits where the… more
- Baylor Scott & White Health (Dallas, TX)
- …of lost wages for payroll and for all approvals of medical bills per claim file. + Pay and process claims within designated authority level + Performs other ... Safe Choice Claims Manager the Safe Choice Claims Specialist II is responsible for the review...establish reserve requirements, identify subrogation potential, maintain diary + Review and evaluate medical and loss wages,… more
- Molina Healthcare (Dallas, TX)
- …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
- Elevance Health (Grand Prairie, TX)
- **Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- Molina Healthcare (Dallas, TX)
- …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
- Baylor Scott & White Health (Dallas, TX)
- …taking initiative and delivering exceptional experience. **Job Summary** You, as a Registered Nurse in the Denial Resource Center at Baylor Scott & White Health, ... manage denials and appeals. Your job is to handle claim denials from all insurance companies, addressing various reasons....side of appeals and denials. + Experience in Utilization Review and Case Management. **Essential Functions of the Role**… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- …and communicates patterns and trends or professional and comprehensive general liability claims experience to the administrative and medical staff. + Makes ... injury. Also, responsible for developing, implementing and monitoring of a quality review program. + Directs the collection, measurement and presentation of data… more