• Medical Claim Review

    Molina Healthcare (Macon, GA)
    …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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  • Clinical Appeals Nurse (RN): Texas and New…

    Molina Healthcare (Macon, GA)
    …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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  • Medical Director (Marketplace)

    Molina Healthcare (Macon, GA)
    …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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