- Molina Healthcare (Lexington, KY)
- …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
- Lincoln Financial Group (Frankfort, KY)
- …organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you ... a clinical resource for Group Protection benefit specialists and claim professionals. You will evaluate medical information...this role you will provide coaching and guidance to claims regarding medical management **What you'll be… more
- Molina Healthcare (Lexington, KY)
- … claims with corresponding medical records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines, and provider ... policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or… more
- CVS Health (Frankfort, KY)
- …health care more personal, convenient and affordable. Position Summary: The Complex Nurse Case Manager is responsible for assessing members through regular and ... implement and coordinate all case management activities with members to evaluate the medical and psychosocial needs of the member to facilitate and support the… more
- Veterans Affairs, Veterans Health Administration (Lexington, KY)
- …objectives of the Medical Center. Provides clinical care (which will include review / approval of outpatient and inpatient CITC consults), review of ... with executive leadership, managerial and clinical leaders in formulating local medical center policy, resource planning for manpower, equipment, and space for… more
- CVS Health (Frankfort, KY)
- …Direct and oversee complex reviews. Ensure timely and accurate reporting of review findings and coordinate with investigative to take appropriate action. Conducts ... detection, investigation, or auditing In-depth knowledge of healthcare systems, claims processing, and regulatory requirements related to healthcare fraud.… more