- Molina Healthcare (Covington, 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
- Elevance Health (Cincinnati, OH)
- **Anticipated End Date:** 2024-09-30 **Position Title:** Clinical Review Nurse I (US) **Job Description:** **Clinical Review Nurse I - Medicare Part A** ... pm EST or CST. Hours are flexible.** The **Clinical Review Nurse I** is responsible for reviewing...and reasonableness of the items supplied in a valid claim through the use of medical policy… more
- Johns Hopkins University (Cincinnati, OH)
- …Permit Exception as required for lab testing provided on-site. + Maintain patient medical records. _Work collaboratively with the Benefits and Safety teams to_ + ... plan health and wellness events and initiative. + Manage workers' compensation claim . + Expand clinic services and reach. + Provide crisis management/intervention,… more
- Elevance Health (Cincinnati, OH)
- …in Oncology and Transplant preferred. + Knowledge of health insurance/benefits, medical management process, care management, and utilization review management ... **Anticipated End Date:** 2024-09-13 **Position Title:** Telephonic Nurse Case Manager II **Job Description:** **Telephonic Nurse Case Manager II** **Location:… more
- Molina Healthcare (Covington, KY)
- …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
- Elevance Health (Cincinnati, OH)
- **Anticipated End Date:** 2024-09-13 **Position Title:** Telephonic Nurse Case Manager II **Job Description:** **Telephonic Nurse Case Manager II** **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 (Mason, OH)
- …procedures. + Investigates potential fraud and over-utilization by performing the most complex medical reviews via prepayment claims review and post payment ... of utilization and/or fraudulent activities by health care providers through prepayment claims review , post payment auditing, and provider record review… more
- Elevance Health (Mason, OH)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,… more
- Veterans Affairs, Veterans Health Administration (Cincinnati, OH)
- Summary The Cincinnati VA Medical Center (VAMC) is searching for a full-time academic Heart Failure Cardiologist to fulfill the current staffing needs of our ... as well as working in conjunction with the Heart Failure RN and nurse practitioner. The multidisciplinary team assists with requests for left ventricular assist… more
- Elevance Health (Cincinnati, OH)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... I** will be responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing incoming calls or… more
- Sedgwick (Cincinnati, OH)
- …the ADA process for claimants requesting accommodations under the ADAAA; to review complex medical information for temporary and permanent accommodation ... are driven to deliver great work. + Apply your medical /clinical or rehabilitation knowledge and experience to assist in...the next round, a recruiter will be in touch. \# nurse Sedgwick is an Equal Opportunity Employer and a… more