Medical Review Nurse -UM/Post Appeals (Michigan RN license req) at Molina Healthcare — NeverHard

Job Description Job Summary Utilizing 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. Job Duties - Facilitates medical review of prospective, retrospective, and concurrent review of appeal…