- University Health (San Antonio, TX)
- …Program (MDCP) and regulatory requirements for the Appeals and Grievances (MDCP/ Appeals ) processes. The Nurse Auditor is a subject matter expert for ... POSITION SUMMARY/RESPONSIBILITIES The Nurse Auditor, using a unique combination of clinical... Auditor is a subject matter expert for the Appeals and Grievances processes ensuring all required processes and… more
- 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
- 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
- CVS Health (Hartford, CT)
- …time zone) with occasional weekends and holidays on a rotation schedule. The Appeals Nurse Consultant position is responsible for processing the medical ... necessity of Medicare Part C appeals from both members and providers. This role is...a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,… more
- Molina Healthcare (Omaha, NE)
- …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...denied cases in which a formal appeals request has been made or upon request by… more
- CVS Health (Hartford, CT)
- …we do it all with heart, each and every day. **Position Summary** The Appeals Nurse Consultant position is responsible for processing the medical necessity of ... Medicare Part C appeals from both members and providers. This role is...a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,… more
- CVS Health (Hartford, CT)
- …business hours 8a-5p in time zone of residence Monday - Friday. The Appeals Nurse Consultant position is responsible for processing the medical necessity ... of Medicare appeals for participating providers. Primary duties may include, but...experience + Utilization Management experience + Coding experience + Appeals experience **Education** + Associate's Degree minimum OR Diploma… more
- Centene Corporation (Columbia, SC)
- …workplace flexibility. **Position Purpose:** Act as the liaison for all statewide appeals , fair hearings, review organizations, and other external type appeals . ... both State and NCQA requirements. + Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services… 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
- 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
- BronxCare Health System (Bronx, NY)
- …the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to ... identification of patterns and trends identified during the course of appeals preparation. Conduct departmental performance improvement audits, analyze findings and… more
- Charter Care Health Partners (Providence, RI)
- Summary: The Clinical Appeals - Author performs appeals and denials management and represents the hospital where claims were denied by either governmental ... duties as required. Education/Licensure: Medical Graduate, Physician Assistant or Registered Nurse (Current RI License) Experience: + Knowledge of third-party payer… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all care sites with ... external third-party payers to appeal denied claims and retrospectively identifies appeals determination as indicated through research and coordination of completion… 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...Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel… more
- State of Colorado (Denver, CO)
- Registered Nurse I-Colorado Mental Health Hospital in Fort Logan-Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5078182) Apply ... Registered Nurse I-Colorado Mental Health Hospital in Fort Logan-Denver Salary...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...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Sterling, CO)
- Nurse Supervisor - Sterling Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5072854) Apply Nurse Supervisor - Sterling Salary $8,369.00 - ... Location Sterling, CO Job Type Full Time Job Number Nurse III 30492 09/2025 Department Department of Corrections Division...Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4963973) Apply CDOC Registered Nurse ( Nurse I) ... Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 06/2025 Department Department of Corrections Division...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Pueblo, CO)
- Registered Nurse II- CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5039700) Apply Registered Nurse II- CMHHIP Salary $45.99 - ... + Description + Benefits + Questions Department Information Registered Nurse II-Full Time CMHHIP This posting will be used...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Pueblo, CO)
- Nurse I - Registered Nurse I -...of the department's action. For more information about the appeals process, the official appeal form, and how to deliver ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5039283) Apply Nurse I - Registered Nurse I - CMHHIP Salary $43.80 - $61.31 Hourly Location… more
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