• Medical Claim Review

    Molina Healthcare (Des Moines, IA)
    …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... more
    Molina Healthcare (01/25/25)
    - Save Job - Related Jobs - Block Source
  • Diagnosis Related Group Clinical Validation…

    Elevance Health (West Des Moines, IA)
    …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... more
    Elevance Health (01/01/25)
    - Save Job - Related Jobs - Block Source
  • Nurse /CPC - Clinical Fraud Investigator…

    Elevance Health (Des Moines, IA)
    ** Nurse /CPC - Clinical Fraud Investigator Senior - SIU Fraud...control. + Review and conducts analysis of claims and medical records prior to payment. + ... more
    Elevance Health (02/13/25)
    - Save Job - Related Jobs - Block Source
  • Clinical Appeals Nurse (RN): Texas and New…

    Molina Healthcare (Des Moines, IA)
    …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... more
    Molina Healthcare (02/09/25)
    - Save Job - Related Jobs - Block Source
  • Initial Review Pharmacy Technician

    Prime Therapeutics (Des Moines, IA)
    …staff, cardholders, and pharmacies. + Escalates medical exception requests to nurse , pharmacist or physician on the utilization review clinical team when ... more
    Prime Therapeutics (02/12/25)
    - Save Job - Related Jobs - Block Source
  • Payment Integrity Clinician - RN (Remote)

    Highmark Health (Des Moines, IA)
    review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure appropriate level of payment and ... more
    Highmark Health (02/13/25)
    - Save Job - Related Jobs - Block Source
  • Medical Director (Medicare)

    Molina Healthcare (Des Moines, IA)
    …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... more
    Molina Healthcare (02/09/25)
    - Save Job - Related Jobs - Block Source
  • Medical Director (Marketplace)

    Molina Healthcare (Des Moines, IA)
    …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... more
    Molina Healthcare (02/06/25)
    - Save Job - Related Jobs - Block Source
  • Psychiatrist

    Veterans Affairs, Veterans Health Administration (Des Moines, IA)
    …issues as requested. As needed, review and co-sign court reports of nurse practitioners if the Medical Director is not available. Complete such reports ... more
    Veterans Affairs, Veterans Health Administration (02/01/25)
    - Save Job - Related Jobs - Block Source
  • Special Investigation Unit Manager Clinical…

    CVS Health (Des Moines, IA)
    …Direct and oversee complex reviews. Ensure timely and accurate reporting of review findings and coordinate with investigative to take appropriate action. Conducts ... more
    CVS Health (12/25/24)
    - Save Job - Related Jobs - Block Source