Join Molina Healthcare as a Clinical Appeals Nurse (RN) where you'll make vital clinical decisions for appeals outcomes. Leverage your nursing expertise to review and assess medical claims, ensuring compliance and quality care. Engage with various departments and represent the organization in hearings.
Key Responsibilities
Perform clinical/medical reviews of previously denied cases
Re-evaluate medical claims and records applying clinical knowledge
Apply appropriate criteria on PAR and Non-PAR cases
Review clinical guidelines with Chief Medical Officer on denial decisions