- Molina Healthcare (Salt Lake City, UT)
- …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 (Salt Lake City, UT)
- …for conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You'll ... 74082 **The Role at a Glance** As an **LTD Claims Specialist** , you will manage a workload of...and consulting physicians to make appropriate, ethical, and timely claim determinations + Reviewing complex medical records… more
- Lincoln Financial Group (Salt Lake City, UT)
- …for conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You'll ... through phone and e-mail to gather information regarding the Short Term Disability claim . + Collaborating with fellow case managers, nurse case managers and… more
- Lincoln Financial Group (Salt Lake City, UT)
- …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
- R1 RCM (Salt Lake City, UT)
- …working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid claims . + Apply clinical judgment and ... Coding Appeals Nurse ** , you will help review and interpret medical records to draft...and underpaid claims . Every day you will review medical records to ensure appropriate coding… more
- Molina Healthcare (Salt Lake City, UT)
- … 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 (Salt Lake City, UT)
- …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
- Evolent (Salt Lake City, UT)
- …other clinicians who review the appeal, the claims department to review provider post-service claims for medical necessity, and managers for ... behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and accomplishments. **What You Will Be Doing:** Communicates with medical office personnel to obtain pertinent clinical history and… more
- United Therapeutics (Salt Lake City, UT)
- …reimbursement support, patient support programs, field reimbursement managers, patient navigators and nurse educators + Review Needs Assessment Forms related to ... and biotech industry, including FDA advertising and promotion, False Claims Act, Anti-Kickback Statute, OIG Guidance, the PhRMA Code,...+ Serve as the Legal representative on the Company's medical communications review , including review … more
- Intermountain Health (Salt Lake City, UT)
- …Prior Authorization RN provides timely review of authorization requests and/or review of denials to ensure medical necessity, payer policies, appeals and ... reviews and submission of complex authorization requests using appropriate criteria, medical policy review and department expectations + Collaborate with… more
- CVS Health (Salt Lake City, UT)
- …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