- 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
- 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
- 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
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …retrospective claim review, special review requests, and UM pre\-certifications and appeals , utilizing medical appropriateness criteria, clinical judgement, and ... for an RN with at least 3 years of clinical experience to join our team\. This position reviews...shifts, 7 AM\-6 PM Eastern Time Zone\. + The nurse does take requests over the phone which requires… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …the use of medical and health care services for members. The SN CHA Nurse may also perform other technical and administrative tasks essential to the efficient ... expert and occasionally works directly with the operation and clinical staff to resolve issues and escalated problems. +...not limited to UM and CM, Fair Hearings and Appeals /Grievances, within three months of working in position. +… more
