- Molina Healthcare (San Antonio, TX)
- …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
- Defense Health Agency (Fort Sam Houston, TX)
- …for arranging, scheduling, and coordinating interview of MEDCEN personnel by the Medical Claims Judge Advocate, Department of Justice or representatives of ... review , referral to an appropriate committee, a Serious Medical Incident Report to the US Army Medical.... Upon receipt of a copy of a malpractice claim , reviews the medical records to identify… more
- Molina Healthcare (San Antonio, TX)
- … 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
- Molina Healthcare (San Antonio, TX)
- …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
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- …are determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Responsibilities The Geriatric and Extended Care ... Medical Practitioner will provide high quality patient centered care...other GEC providers. - Participates in chart reviews, peer review and other process improvement initiatives. The staff will… more