- USAA (Paradise Valley, AZ)
- … and/or Medicare-related claims . Expert Advice: Ability to review complicated medical records and medical claims , and provide expert advice. Conducts ... for Health Claims for the approach to medical risk assessment rules. Guides and trains claim...review of complex healthcare fraud investigations and providing claims support Medical Coding Proficiency: At least… more
- Molina Healthcare (Phoenix, 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
- USAA (Phoenix, AZ)
- …Medicare-related claims . + Expert Advice: Ability to review complicated medical records and medical claims , and provide expert advice. Conducts ... us special and impactful. **The Opportunity** USAA Life Company's Claim Team is seeking a talented ** Medical ...review of complex healthcare fraud investigations and providing claims support + Medical Coding Proficiency: At… more
- Molina Healthcare (Phoenix, AZ)
- …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 (Phoenix, AZ)
- …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 (Gilbert, 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)
- …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
- 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
