- Bluestone Child & Adolescent Psychiatric Hospital (University Heights, OH)
- …skills. Experience: A minimum of 1 year experience as a psychiatric nurse . 1-2 years-experience in behavioral health utilization review preferred. AGENCY ... response to emails and other communications relating to utilization review . Prepare and submit appeals utilizing their...tracking as needed. Perform all duties of the Psychiatric Nurse ( RN /LPN) role as needed or when… more
- Unknown (Reno, NV)
- …teaching in nursing programs, and direct patient care as a registered nurse . The role requires a current RN license, experience in supervision, planning, ... in nursing faculty meetings and ensuring the quality of instruction through program review and strategic planning. Applicants must have a Master's degree or higher… more
- Adecco US, Inc. (Minneapolis, MN)
- …per week, eight-hour days **Pay:** $40.50 to $42.50 an hour **Responsibilities of the RN Appeals Reviewer :** . Responsible for conducting thorough reviews of ... high-quality work and meeting production goals. **Qualifications for the RN Appeals Reviewer :** . Associates...and Holiday pay upon meeting eligibility criteria. **IMPORTANT:** This ** Registered Nurse ** role is being recruited for… more
- AmeriHealth Caritas (Philadelphia, PA)
- …process, preferably within a managed care organization **Licensure:** + Current and unrestricted Registered Nurse ( RN ) licensure or compact state licensure ... **Role Overview: ;** The Clinical Appeals Reviewer is responsible for processing...appeals , ensuring compliance with all regulatory milestones + Review medical records to identify Hospital-Acquired Conditions (HAC), ensure… 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 ... + Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- LA Care Health Plan (Los Angeles, CA)
- …the ability to manage multiple training initiatives simultaneously. Licenses/Certifications Required Licensed Registered Nurse ( RN ) - Active, current and ... Lead Customer Solution Center Appeals and Grievances RN Job Category:...clinical unit. This position is responsible for the quality review of complex and/or escalated clinical A&G cases for… more
- MVP Health Care (Tarrytown, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join #TeamMVP. If you have a ... you'll bring:** + Current and unrestricted NY & VT RN licensure + Associate or bachelor's degree in nursing...and UM platforms. + Familiarity with CMS regulations and appeals processes. + Ability to work independently and manage… more
- State of Colorado (Denver, CO)
- …(HP III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5155064) Apply Registered Nurse Health Compliance Inspector Home Care - ... a measurable difference in the health, safety, and well-being of Colorado communities. As a Registered Nurse ( RN ) Health Professional III , you will use your… more
- Elevance Health (Columbus, OH)
- ** Nurse Appeals RN ** **Location** : Ohio-Cincinnati, Columbus, Mason, or Seven Fields _(Must be within commutable distance to the listed locations.)_ ... an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and...medical information for medical director, consultants and other external review . + Prepares recommendations to either uphold or deny… more
- CommonSpirit Health (Centennial, CO)
- …Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive experience in utilization ... resources to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for… more
- Elevance Health (Tampa, FL)
- ** Nurse Appeals ** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and...medical information for medical director, consultants and other external review . + Prepares recommendations to either uphold or deny… more
- Centene Corporation (Trenton, NJ)
- …State Licensure required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… more
- Centene Corporation (Jefferson City, MO)
- …State Licensure required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… more
- State of Colorado (Grand Junction, CO)
- Registered Nurse I, RN I - Grand Mesa Youth Services Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5157862) Apply ... Registered Nurse I, RN I...laboratory and other diagnostic procedures ordered by medical providers, review results and notify provider of results when indicated.… more
- CareFirst (Baltimore, MD)
- …strategies to improve individual and team-based performance as needed. **Licenses/Certifications** : + RN - Registered Nurse - State Licensure And/or Compact ... of appeals and reconsiderations, including Regulatory complaints and External review requests. Accountable for quality review and interpretation of the… more
- Nuvance Health (Danbury, CT)
- …Days, Evenings, Nights available* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within ... behaviors to internal leadership for assistance in resolution. *Responsibilities* * Review all inpatient admission and observation cases using InterQual, or Milliman… more
- BronxCare Health System (Bronx, NY)
- …response by the department physician advisors and clinical staff. Qualifications - NYS Registered Nurse required - The Appeal Manager must have excellent verbal ... Overview The Appeals Manager is responsible to assist in the...tasks. -Assists the Administrative Manager and Director with annual review and revisions of departmental policies, and procedures as… more
- Elevance Health (Indianapolis, IN)
- ** Nurse Appeals ** **Location: Indiana** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... an accommodation is granted as required by law. The ** Nurse Appeals ** is responsible for investigating and...preferred. + 3 years of clinical experience as a Registered Nurse is strongly preferred. + Experience… more
- Centene Corporation (Salem, OR)
- …on workplace flexibility. **Position Purpose:** Act as the liaison for all statewide appeals , fair hearings, review organizations, and other external type ... all appeal letters generated comply with both State and NCQA requirements. + Review clinical information for all appeals utilizing nationally recognized criteria… more
