• Medical Claim Review

    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
    Molina Healthcare (01/25/25)
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  • Workers Compensation Claim Analyst

    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
    Travelers Insurance Company (02/14/25)
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  • Claims Specialist II

    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
    Baylor Scott & White Health (03/04/25)
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  • Clinical Appeals Nurse (RN): Texas and New…

    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
    Molina Healthcare (02/09/25)
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  • Telephonic Nurse Case Mgr II

    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
    Elevance Health (03/11/25)
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  • Medical Director (Marketplace)

    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
    Molina Healthcare (02/06/25)
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  • Denial Resource Center RN (Hybrid Remote/Onsite)

    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
    Baylor Scott & White Health (03/09/25)
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  • Director QA/PI/Risk Management

    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
    Dallas Behavioral Healthcare Hospital (03/07/25)
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