- Monster (Allentown, PA)
- …Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending. Coordinates RAC ... appeals for complex case reviews for medical necessity, including...monotony. EDUCATION: Graduate of an accredited professional nursing program.Registered nurse with current license to practice in the state… more
- jobvibe (Sayre, PA)
- …Operations* Administrative Support* Reception, Clerical, Call Center* Claims Appeals /Denials/Reimbursement* Insurance Pre-Authorizations* Medical ... WCS Healthcare Partners is seeking a travel nurse RN Med Surg / Telemetry for a...diagnoses. Monitor patients on telemetry, including both on-unit and remote monitoring. Interpret and manage dysrhythmias. Administer oxygen via… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & Grievances ... (A&G) & General Operations ( Clinical ) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals & Grievances… more
- Centene Corporation (Columbia, SC)
- …analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters ... for member and provider clinical appeals and ensure letters are compliant...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
- CVS Health (Columbus, OH)
- …support cost-effective quality care for members. Administers review and resolution of clinical complaints and appeals . Interprets data obtained from clinical ... regulatory and accreditation requirements for members and providers. Coordinates clinical resolutions with internal and external support areas. **Required… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all ... need the following: Required Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive… more
- Henry Ford Health System (Troy, MI)
- …GENERAL SUMMARY: Unit Description: Health Alliance Plan (HAP) is looking to grow our Medical Appeals Team with an experienced Registered Nurse ! We are a team of ... RN PROVIDER APPEALS COORDINATOR - MEDICAL APPEALS -...through Friday, 8:00AM to 4:30PM. This position is primarily remote with the possibility of in person meetings and… more
- Prime Therapeutics (Atlanta, GA)
- …passion and drives every decision we make. **Job Posting Title** Infusion Referral Nurse Sr- REMOTE **Job Description** Under supervision, is responsible for ... these cases in web-based application and spreadsheets. + Supports clinical services such as the appeals program....work visa or residency sponsorship **Additional Qualifications** + Registered Nurse (RN). + 5 years of post-degree clinical… more
- St. Luke's University Health Network (Allentown, PA)
- …+ Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending. + Coordinates RAC ... appeals for complex case reviews for medical necessity, including...EDUCATION: Graduate of an accredited professional nursing program. Registered nurse with current license to practice in the state… more
- Providence (OR)
- …best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide care ... nearing end of life + Care management services include: nurse education, care coordination and general assistance with managing...care to our members **Providence Health Plan welcomes 100% remote work to residents who reside in the following… more
- Virtua Health (Mount Laurel, NJ)
- …over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques ... neurosciences, and the Children's Hospital of Philadelphia for pediatrics. Location: 100% Remote Currently Virtua welcomes candidates for 100% remote positions… more
- State of Colorado (Denver, CO)
- …assigning responsibilities + During specific shifts, functions in the role of Charge Nurse and provides clinical and administrative supervision of nursing staff ... of work, providing clinical leadership and teaching clinical interventions + Functions as the Charge Nurse...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Denver, CO)
- Charge Nurse RN II (Internal Pool)- CO Mental Health Hospital in Fort Logan (S. Denver) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5076532) ... Apply Charge Nurse RN II (Internal Pool)- CO Mental Health Hospital...coordinates and implements medical and psychiatric crisis intervention in clinical emergencies assuring compliance with nursing standards and policies/procedures.… more
- State of Colorado (Pueblo, CO)
- Registered Nurse III- House Supervisor -CMHHIP Nursing Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5074407) Apply Registered Nurse ... state of residence to another state within the Enhanced Nurse Licensure Compact (eNLC), you must apply for a...24th St, Pueblo, CO 81003 On-Site, In Person No Remote Options Available About the Position: The purpose of… more
- State of Colorado (Garfield County, CO)
- NURSE I - Veterans Community Living Center at Rifle Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4907915) Apply NURSE I - Veterans ... requirements. + Performs both admission and daily assessments during clinical stay, identifying critical stay, identifying critical incidents, emergencies, acute… more
- State of Colorado (Aurora, CO)
- …+ Coach, mentor, and guide all CNAs, LPNs, and RNs on proper procedures/protocols on clinical /nursing practices + Act as a floor nurse or charge nurse , ... Nurse Manager/Staffing Development Coordinator-Veterans Community Living Center Fitzsimons...as able + Develop and implement staff development and clinical education strategic goals that are in alignment with… more
- State of Colorado (Garfield County, CO)
- …physician's orders, facilitate shift reports, act as liaison between shift, head nurse and other clinical management staff, communicate incidents and injuries, ... NURSE III - Rifle Veteran's Community Living Center...and competencies necessary to the position through continuing education, clinical supervision, literature review and participating in discipline and… more
- State of Colorado (Golden, CO)
- Registered Nurse I, RN I - Campus at Lookout Mountain, Youth Services Center - Golden Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5008113) ... Apply Registered Nurse I, RN I - Campus at Lookout Mountain,...including physical, psychiatric and dental maintenance. Specific Job Duties: Clinical Duties: Initial nursing assessments and triage of requests… more
- Molina Healthcare (Warren, MI)
- …resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical ... that has a current active unrestricted license This a remote role and can sit anywhere within the United...set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing… more
- US Tech Solutions (RI)
- …as needed, and transfers all clinical questions and judgement calls to the Clinical Pharmacist as needed. + The Nurse Associate LPN will also assist with ... **Location: REMOTE ** **Timing: 8-hour shift Monday to Friday anywhere...weekends** **Duration: 6 Months +** **Job Description:** + The Nurse Associate LPN - Prior Authorization is responsible for… more
