- Molina Healthcare (Chandler, 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
- Lincoln Financial Group (Phoenix, AZ)
- …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 (Phoenix, AZ)
- …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 (Phoenix, AZ)
- …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
- CVS Health (Phoenix, AZ)
- …and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. RN ... - Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit...and multiple diagnoses that impact functionality. - Reviews prior claims to address potential impact on current case management… more
- Molina Healthcare (Chandler, AZ)
- … 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 (Chandler, 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 (Phoenix, AZ)
- …students, medical /podiatry residents, and midlevel providers, and will supervise nurse anesthetists. Phoenix VA Health Care System has no established residency ... the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible...and skills, opportunities for the teaching and supervision of medical residents, medical students, nurse … more
- Evolent (Phoenix, AZ)
- …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 (Phoenix, AZ)
- …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 (Phoenix, AZ)
- …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
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …of the cardiology section including cardiology physicians, physician assistants, nurse practitioners, nurses, diagnostic radiology technicians, medical ... determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.… more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... therapy and follow up for these disorders. Teaching and supervision of Medical Students and Physicians-in-training is an integral component of the position. The… more
- Veterans Affairs, Veterans Health Administration (Phoenix, 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)
- …Plans. - Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most ... Arizona Time zone. The Care Management Associate (CMA) supports comprehensive coordination of medical services that include intake and outgoing calls for medical … 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