- Premera Blue Cross (Mountlake Terrace, WA)
- …through our Healthsource blog: https://healthsource.premera.com/ . The **Care Coordinator** - ** Clinical Appeals ** performs prospective review (benefit ... **Pacific Time** **What you'll do:** + Performs medical necessity review that includes inpatient review , concurrent ...+ Current State Licensure as a registered nurse (REQUIRED) + Three (3) years of clinical… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is seeking a highly motivated and results-driven **UM RN Appeals Coordinator.** This role collaborates with clinical review staff, ... evenings and weekends, to address pharmacy-related denials + Educates physician reviewers and clinical review staff on managed care and Medicaid policies and… more
- Stanford Health Care (Palo Alto, CA)
- …Days or + CCDS - Cert Clinical Document Spec required within 180 Days + RN - Registered Nurse - State Licensure And/Or Compact State Licensure required . ... Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and...likelihood of a successful appeal. + Proofreading and Editing: Review and edit appeals for clarity and… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …appeals and acquire authorizations for treatment **Key Qualifications:** + Current NYS Registered Nurse License/Registration and BSN preferred + At least 2-3 ... Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of… more
- Alameda Health System (San Leandro, CA)
- …AHA-American Heart Association. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. **PAY RANGE** ... SLH Case Manager RN + San Leandro, CA + San Leandro...Two years related in acute care facility and/or utilization review training. Minimum Experience: Varied clinical experience… more
- St. Luke's University Health Network (Allentown, PA)
- …communities we serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- Centene Corporation (Jefferson City, MO)
- …Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** RN - Registered Nurse - State Licensure ... requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent...- Licensed Vocational Nurse required or + RN - Registered Nurse -… 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 ... analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with... requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse ( RN ) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & ... + Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Appeals regulatory guidelines including URAC, NCQA, and ERISA + Proficiency in Clinical Appeals , Utilization Review , and Grievance processes including ... to its clients, ensuring high-quality, clinically sound decision-making. The Clinical Appeal and Grievance Nurse is responsible...throughout employment + Minimum of 5 years' experience in Clinical Appeals and Grievances within a managed… more
- State of Colorado (Denver, CO)
- …(HP III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5112485) Apply Registered Nurse Health Compliance Inspector Home Care - ... health, safety, and well-being of Colorado communities. As a Registered Nurse ( RN ) Health Professional...through direct observation, staff and consumer interviews, and record review . + Applying professional judgment and clinical … more
- State of Colorado (Denver, CO)
- …III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5084845) Apply Registered Nurse , Health Compliance Inspector, Complaints ... Registered Nurse , Health Compliance Inspector, Complaints...Section - FAA00710 (HP III RN ) Salary $80,916.00 Annually Location Denver, CO Job Type… more
- State of Colorado (Denver, CO)
- …III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5120373) Apply Registered Nurse Health Compliance Inspector, Nursing ... Registered Nurse Health Compliance Inspector, Nursing...Facilities - FAA00221 (HP III RN ) Salary $80,916.00 Annually Location Denver, CO Job Type… more
- State of Colorado (Lakewood, CO)
- Registered Nurse I, RN I - Campus at Mount View, Youth Services Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5115656) Apply ... Registered Nurse I, RN I...including physical, psychiatric and dental maintenance. Specific Job Duties: Clinical Duties: Initial nursing assessments and triage of requests… more
- Nuvance Health (Danbury, CT)
- …REQUIRED* * *Hybrid/Remote* * *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within ... critical part in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with CMS requirements,… more
- CareFirst (Baltimore, MD)
- …strategies to improve individual and team-based performance as needed. **Licenses/Certifications** : + RN - Registered Nurse - State Licensure And/or Compact ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates...appeals and reconsiderations, including Regulatory complaints and External review requests. Accountable for quality review and… more
- Sacramento County (Sacramento, CA)
- …read and understood the above instructions. 02 Select the one box that best describes your Registered Nurse ( RN ) license issued by the State of California. + ... Registered Nurse D/CF (Level I/II) Print...+ Use and care of medical equipment used in clinical and infirmary settings + Basic medical indications of… 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 ...**Education Level:** High School Diploma or GED **Licenses/Certifications:** + RN - Registered Nurse -… 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...appeals , ensuring compliance with all regulatory milestones + Review medical records to identify Hospital-Acquired Conditions (HAC), ensure… more
- State of Colorado (Pueblo, CO)
- Nurse I - Registered Nurse...This position is responsible for assisting nursing staff with clinical direction of nursing staff, QA/PI activities and to ... - CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5101894) Apply Nurse I - Registered Nurse I - CMHHIP Salary $43.80 - $61.31… more
