- Molina Healthcare (Chandler, AZ)
- …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 (Phoenix, AZ)
- …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
- Indian Health Service (Phoenix, AZ)
- … medical center's improvement methodology and framework, and external review standards. Works within general programmatic authority delegated by Department ... care to assess for potentially compensable events. Coordinates Administrative Tort Claims , interfacing with legal counsel, medical staff, supervisors, directors,… more
- Molina Healthcare (Chandler, AZ)
- … 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
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …of the cardiology section including cardiology physicians, physician assistants, nurse practitioners, nurses, diagnostic radiology technicians, medical ... determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.… more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... with clinic operations. Will work in a team setting with other physicians, nurse practitioners, registered nurses, and support staff assigned to perform duties to… more
- CVS Health (Phoenix, AZ)
- …Plans. - Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most ... Arizona Time zone. The Care Management Associate (CMA) supports comprehensive coordination of medical services that include intake and outgoing calls for medical … more
- CVS Health (Phoenix, AZ)
- …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