Expired Clinical Review Nurse jobs in Detroit, MI
Detroit, MI
$36,272-$102,145/year (est.)
Position Purpose: This position reviews and audits all adverse decisions for members of the health plan while utilizing clinical expertise and specific tools for best practice and compliance. Clinical audits focus on medical and behavioral health utilization denials. Maintains Federal and Local...
Detroit, MI
$36,272-$102,145/year (est.)
At WellCare, we are a passionate team with a strong mission and a focused purpose: to serve our members and local communities in which they live while helping them lead better, healthier lives. Our culture is one of empowerment, teamwork and commitment as we all work together to deliver...
Detroit, MI
$36,272-$102,145/year (est.)
Responsibilities: Responsible for reviewing all aspects of the denial processes to promote consistency and accuracy within the processes and compliance with Medicare, NCQA, URAC or general accreditation, regulatory and HIPAA guidelines Develop and maintain a current knowledge of Meridian Health...
Detroit, MI
$36,272-$102,145/year (est.)
Overview Who we are: Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry. We provide government-based health plans (Medicare, Medicaid,...