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Job Description
Join Molina Healthcare as a Clinical Appeals Nurse (RN) and utilize your clinical expertise to make impactful decisions on appeals outcomes. In this role, you'll review denied cases, ensure compliance with regulations, and serve as a resource for various departments while mentoring junior staff.
Key Responsibilities
Perform clinical/medical reviews of previously denied cases
Re-evaluate medical claims and associated records
Apply appropriate criteria on PAR and Non-PAR cases
Review denial decisions with Chief Medical Officer