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Licensed Vocational Nurse
2 weeks ago
Aveanna Healthcare Long Beach, United StatesAveanna Healthcare, the largest pediatric home health care company in the U.S., is hiring compassionate Licensed Vocational Nurses (LVN) to provide skilled nursing care to patients in the home setting. We are the hearts of 40,000 caregivers and trusted by over 33,000 families. · ...
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Coordinator, Licensing
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Hybrid Promtions LLC Cypress, United StatesHybrid's humble beginnings started in 1997 in the back of a print shop designing, selling, and printing tee shirts. Today, Hybrid is a global apparel industry powerhouse in brand and licensing management. Hybrid provides its expertise and fully vertical operations capability - de ...
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Licensed Vocational Nurse
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Aveanna Healthcare Torrance, United StatesAveanna Healthcare, the largest pediatric home health care company in the U.S., is hiring compassionate Licensed Vocational Nurses (LVN) to provide skilled nursing care to patients in the home setting. We are the hearts of 40,000 caregivers and trusted by over 33,000 families. · ...
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Licensing Administrator
3 weeks ago
Bandai Namco Entertainment America Inc. Irvine, United States*** · The Licensing Administrator will work with the IP Licensing department globally to support licensing tasks in IP Strategy department. The primary job responsibilities involve assisting the Licensing business with administrative and support tasks ranging from assisting appro ...
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Licensing Admin
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MedInformatix (Medinformatix) Los Angeles, United States**Job Content** · **Summary**:The Licensing Administrator and Accounting Clerk are responsible for managing all aspects related to the Company's licensing. This includes reviewing requests, releasing licenses, tracking and monitoring all transactions, and collaborating with the a ...
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Licensing Manager
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Leadstack Inc Burbank, United StatesLeadStack Inc. is an award-winning, one of the nation's fastest-growing, certified minority-owned (MBE) staffing services provider of the contingent workforce. As a recognized industry leader in contingent workforce solutions and Certified as a Great Place to Work, we're proud to ...
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License Administrator
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Aveva Lake Forest, United StatesAVEVA is a global leader in industrial software. Our cutting-edge solutions are used by thousands of enterprises to deliver the essentials of life - such as energy, infrastructure, chemicals and minerals - safely, efficiently and more sustainably. · We're the first software busin ...
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Licensing Coordinator
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License Owner
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Stranger Soccer Los Angeles, United States**About The Job**:** Passionate about football (soccer) AND about business? Stranger Soccer is expanding to key cities around the world. We are looking for a License Owner to open and operate the Stranger Soccer business in Los Angeles.** · This is not your traditional management ...
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Licensing Coordinator
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DBA Media, LLC West Hollywood, United States: · Digital Brand Products is now the United Talent Agency Creators Product Group. · We are seeking a Licensing Coordinator to work directly with the head of UTA CPG. · UTA CPG is a leader in helping talent and digital influencers build brands at retail. Passion for the creator e ...
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Licensing Administrator
1 week ago
MedInformatix (Medinformatix) Los Angeles, United States**Summary**:The Licensing Administrator and Accounting Clerk are responsible for managing all aspects related to the Company's licensing. This includes reviewing requests, releasing licenses, tracking and monitoring all transactions, and collaborating with the accounting departme ...
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Licensing Manager
4 days ago
Bandai Namco Entertainment America Inc. Irvine, United States*** · The Licensing Manager at Bandai Namco Entertainment America Inc. is responsible for leading the overall licensing brand strategy for all core gaming IPs for The Americas territories and any potential international merchandise licensing programs. This role entails day-to-day ...
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Licensing Coordinator
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Mattel El Segundo, United States**Company Description** CREATIVITY IS OUR SUPERPOWER.** It's our heritage and it's also our future. Because we don't just make toys. We create innovative products and experiences that inspire fans, entertain audiences and develop children through play. Mattel is at its best when ...
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Licensed Therapist
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Licensing Assistant
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FAM Brands Los Angeles, United StatesFounded in 2000, FAM Brands designs, manufactures, and sells men's and women's sportswear and active wear apparel to major retailers, big box stores, and specialty boutiques across the country and throughout the world. Our portfolio of proprietary brands features Marika, Wildfox, ...
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Licensed Vocational Nurse
2 weeks ago
Aveanna Healthcare Huntington Beach, United StatesAveanna Healthcare, the largest pediatric home health care company in the U.S., is hiring compassionate Licensed Vocational Nurses (LVN) to provide skilled nursing care to patients in the home setting. We are the hearts of over 40,000 caregivers and trusted families. · Ask us abo ...
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Licensed Insurance
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Allstate Insurance West Covina, United States**PLEASE ONLY APPLY IF YOU ARE LICENSED: PERSONAL LINES OR P&C** · We are seeking a dedicated sales mentality person with a customer service attitude. This is a rewarding position with competitive pay that is both hourly and high commission potential with an opportunity for annua ...
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Licensed Dental Hygienist
2 weeks ago
Lakeside Dental Center Orange Park, United StatesLakeside Dental Center is looking for a Dental Hygienist to join our 9 member team · $5K WELCOME BONUS · PART-TIME · Located at: · 2511 Saint Johns Bluff Rd SSte 206Jacksonville, Florida 32246As an elite clinical provider and patient advocate, you'll receive best in class non-c ...
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Licensed Practical Nurse
2 weeks ago
BAYADA Home Health Care New Florence, United StatesCome for the Flexibility, Stay for the Culture · Are you feeling burned out? Craving work-life balance? · BAYADA Offers Our Licensed Practical Nurses: · One on one care · Flexible scheduling based on your preferences · Weekly pay · Preventive Care Coverage for ALL employees (PRN ...
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Licensed Therapist
3 weeks ago
U.S. VETS Long Beach, United States Full timeLicensed TherapistThis Licensed Therapist position reports directly to the Director of Behavioral Health and is responsible for providing a range of psychosocial services including community outreach, counseling (individual and group), and referral services as part of a multidisc ...
Medical Claim Review Nurse Remote with MI RN License - Long Beach, United States - Molina Healthcare
Description
Job DescriptionJOB DESCRIPTIONJob SummaryUtilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers.
Remote position.
Work hours:
Monday - Friday 8:30am to 5:00PM
Additional work schedule:
Every 5 weeks Friday coverage is from 9 to 5:30pm Job Duties Performs clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which an appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing.
Identifies and reports quality of care issues.Assists with Complex Claim review including DRG Validation, Itemized Bill Review, Appropriate Level of Care, Inpatient Readmission, and any opportunity identified by the Payment Integrity analytical team; requires decision making pertinent to clinical experience Documents clinical review summaries, bill audit findings and audit details in the database Provides supporting documentation for denial and modification of payment decisions Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of all relevant and applicable Federal and State regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care.
Reviews medically appropriate clinical guidelines and other appropriate criteria with Medical Directors on denial decisions. Supplies criteria supporting all recommendations for denial or modification of payment decisions. Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. Provides training and support to clinical peers. Identifies and refers members with special needs to the appropriate Molina Healthcare program per policy/protocol.JOB QUALIFICATIONSGraduate from an Accredited School of NursingREQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
Minimum 3 years clinical nursing experience. Minimum one year Utilization Review and/or Medical Claims Review.
Minimum two years of experience in Claims Auditing, Medical Necessity Review and Coding experience Familiar with state/federal regulationsREQUIRED LICENSE, CERTIFICATION, ASSOCIATION:
Active, unrestricted State Registered Nursing (RN) license in good standing
MI RN licensurePREFERRED EDUCATION:
Bachelors' Degree in Nursing or Health Related Field
PREFERRED EXPERIENCE:
Nursing experience in Critical Care, Emergency Medicine, Medical Surgical, or Pediatrics. Advanced Practice Nursing. Billing and coding experience.
Appeals or claim review knowledgeMust be computer skilled with the ability to navigate between numerous programs at oncePREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
Certified Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional Healthcare Management, Certified Professional in Healthcare Quality or other healthcare certification
To all current Molina employees:
If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.