- Premera Blue Cross (Mountlake Terrace, WA)
- …blog: https://healthsource.premera.com/ . The **Care Coordinator** - **Clinical Appeals ** performs prospective review (benefit advisory/ prior authorization) ... (4) years' work experience (REQUIRED) + Current State Licensure as a registered nurse (REQUIRED) + Three (3) years of clinical experience (REQUIRED) + Utilization… more
- Genmab (Berkeley Heights, NJ)
- …verifications, research of prior authorizations and support through the appeals processEvaluate and refer patients to appropriate financial assistance ... Call CenterCollaborate with PSS Field Teams (Field Reimbursement Managers and Nurse Team) to ensure seamless communication and appropriate handoffs when… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …BroadPath is seeking a highly motivated and results-driven **UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical ... to ensure consistent clinical evaluation and processing of medical necessity appeals . Accurate documentation and detailed recordkeeping of notifications to members… more
- Jobleads-US (New York, NY)
- …Contribute to continuous performance improvement initiatives. Prepare and manage appeals processes. Track and manage grievances. Analyze patient satisfaction data ... care and staff support. Requirements Active New York State (NYS) Registered Nurse (RN) License. Strong knowledge of Certified Home Health Agency (CHHA) regulations… more
- Stanford Health Care (Palo Alto, CA)
- …the Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and denials. This position requires strong ... analytical and communication skills. The Clinical Government Audit Analyst and Appeals Specialist II will collaborate with clinical staff, coding professionals, and… more
- PharmaCord (Jeffersonville, IN)
- …closure to include; benefit investigations, prior authorizations / denial appeals , determining financial qualifications for assistance programs and assisting ... to follow up on proper submission and/or outcome Coordinates nurse teach with field-based nurse educators, as...and/or outcome Coordinates nurse teach with field-based nurse educators, as applicable to program Supports adherence services… more
- MVP Health Care (Tarrytown, NY)
- …Qualifications you'll bring: Current New York State Licensure as a Registered Nurse required. Certification in Case Management required within 24 months after hire. ... to maintain cost-effectiveness and manage Medical Loss Ratio (MLR). Appeals & Denials: Participate in the appeals ...(MLR). Appeals & Denials: Participate in the appeals process for denied services and ensure timely resolution.… more
- Alameda Health System (San Leandro, CA)
- …other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed. + Encourages patients to develop realistic plans. Makes ... in case management/community health preferred. Preferred Licenses/Certification: Public Health Nurse , Case Management, or Home Health. Required Licenses/Certifications: BLS… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …+ Work with insurance carriers and MSKCC billing departments to initiate appeals and acquire authorizations for treatment **Key Qualifications:** + Current NYS ... Registered Nurse License/Registration and BSN preferred + At least 2-3 years of clinical hospital nursing experience + Managed care/UR/CM experience strongly… more
- Elevance Health (Charlotte, NC)
- ** Nurse Appeals - Litigation & Legal Support** **Location:** North Carolina, candidates must be residents of North Carolina to be considered. **In Office ... will be necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support** is responsible for investigating and processing… more
- Elevance Health (Atlanta, GA)
- ** Nurse Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... shift between those hours, including holidays on a rotational basis. The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … 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 Location: Los ... the safety net required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding ... adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all applicable State and Federal rules and… more
- CVS Health (Phoenix, AZ)
- …with heart, each and every day. **Position Summary** CVS Aetna is seeking a dedicated ** Appeals Nurse Consultant** to join our remote team. In this role, you ... a critical role in ensuring fair and accurate resolution of clinical appeals by applying sound clinical judgment and regulatory knowledge. **Key Responsibilities** +… more
- Penn State Health (Hershey, PA)
- …that prohibit or outlaw discrimination._ **Union:** Non Bargained **Position** Clinical Appeals Nurse - Revenue Integrity Process **Location** US:PA: Hershey ... required. + Currently licensed to practice as a Registered Nurse by state of employment or holds a multistate...Licensure Compact. + Prior experience with denial management and appeals required. + Familiarity with payer guidelines. + Excellent… more
- TEKsystems (San Bernardino, CA)
- Description We are seeking a dedicated Clinical Appeals Nurse to join our Revenue Cycle Management team. The ideal candidate will be responsible for managing ... involves reviewing medical records, preparing clinical documentation to support appeals , and following up on submitted appeals ....support appeals , and following up on submitted appeals . The Clinical Appeals Specialist will work… more
- Mount Sinai Health System (New York, NY)
- …for appeals , On / Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in ... department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status of… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate implementation of the clinical appeal process for members ... Directs the activities and serves as a resource for associates within the Appeals and Grievances Department for Government Programs. We are looking for an… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals correspondence, and determination of next ... for collecting, organizing and tracking information to facilitate and expedite processing of appeals received from a variety of sources. We are looking for an… more
- Centene Corporation (Jefferson City, MO)
- …**Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more
