- Molina Healthcare (Salt Lake City, UT)
- …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
- R1 RCM (Salt Lake City, UT)
- …working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid claims . + Apply clinical judgment and ... Coding Appeals Nurse ** , you will help review and interpret medical records to draft...and underpaid claims . Every day you will review medical records to ensure appropriate coding… more
- R1 RCM (Salt Lake City, UT)
- …experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical records and payer denial information submitted by clients ... justified for that hospital stay or service using evidence-based guidelines. + Review governmental regulations, payer protocols, and/or medical policy to… more
- Molina Healthcare (Salt Lake City, UT)
- …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 (Salt Lake City, UT)
- …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
- University of Utah Health (Salt Lake City, UT)
- …high dollar and frequent utilizers. + Collaborate with unit case manager, utilization review nurse and other organization staff on establishing an appropriate ... and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes. **Responsibilities** + Daily identification… more
- R1 RCM (Salt Lake City, UT)
- …prior leadership experience in medical record reviews and extensive knowledge of medical coding for inpatient and outpatient claims , as well as reimbursement ... experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines...coders and coding team members who conduct a comprehensive review of coding denials and formulate appeals based on… more
- CVS Health (Salt Lake City, UT)
- …Manager role includes: -Collaborate with an interdisciplinary care management team ( nurse case managers, medical directors, dietitians, social workers) to ... their path to better health, decrease hospital readmissions, and reduce medical costs. -Provide comprehensive medication reviews, drug information, and education.… more
- Evolent (Salt Lake City, UT)
- …and write clearly. + Reviews adverse determinations against criteria and medical policies + Creates adverse determination notifications that meet all accreditation, ... + Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director. + Appropriately identifies potential cases… more
- CVS Health (Salt Lake City, UT)
- …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