- Molina Healthcare (Omaha, NE)
- … decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… 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 ... administrative duties as required. Education/Licensure: Medical Graduate, Physician Assistant or Registered Nurse (Current RI License) Experience: + Knowledge of… more
- Centene Corporation (Sacramento, CA)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... Required** **Schedule M-F 8-5PM PST** **Does not require CA residency** **Provider appeals exp preferred** **Position Purpose:** Performs clinical reviews needed… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …with resources to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management ... will need the following: Required Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with… 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
- 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 ... in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates...Utilization Review experience - Medicare experience - Managed Care Appeals experience **Education** Associate's degree or RN … more
- CVS Health (Tallahassee, FL)
- …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 ... a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,...in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates… more
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals ... Responsibilities include but not limited to: Receives, manages and provides clinical reviews and/or submissions as required by contractual or regulatory… more
- CVS Health (Columbus, OH)
- … resolutions with internal and external support areas. **Required Qualifications** + A Registered Nurse that must hold an unrestricted license in their state ... support cost-effective quality care for members. Administers review and resolution of clinical complaints and appeals . Interprets data obtained from clinical… more
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... Coder (CIC), Registered Health Information Management Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Clinical Documentation… more
- Houston Methodist (Sugar Land, TX)
- …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or...care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge… more
- Beth Israel Lahey Health (Cambridge, MA)
- …high reliability processes to reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, ... skills to prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for medical peer review.… more
- Corewell Health (Royal Oak, MI)
- …experience in care management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan License Upon ... criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization… more
- State of Colorado (Denver, CO)
- …(HP III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5058918) Apply Registered Nurse Complaints Health Compliance Inspector - ... Registered Nurse Complaints Health Compliance Inspector -...FAA00731 (HP III RN ) Salary $80,916.00 - $90,648.00 Annually Location Denver, CO Job… more
- State of Colorado (Denver, CO)
- …III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5075443) Apply Registered Nurse Health Compliance Inspector, Nursing ... Registered Nurse Health Compliance Inspector, Nursing...Facilities - FAA00867 (HP III RN ) Salary $80,916.00 Annually Location Denver, CO Job Type… 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, Youth Services Center… more
- Henry Ford Health System (Troy, MI)
- …Alliance Plan (HAP) is looking to grow our Medical Appeals Team with an experienced Registered Nurse ! We are a team of Registered Nurses (3 and counting) ... RN PROVIDER APPEALS COORDINATOR - MEDICAL...Microsoft Word. Excel and Access preferred. CERTIFICATIONS/LICENSURES REQUIRED: + Registered Nurse ( RN ) with current… more
- Corewell Health (Dearborn, MI)
- …experience in care management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan Upon Hire ... criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization… more
- Beth Israel Lahey Health (Boston, MA)
- …directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse ( RN ), Massachusetts + Three years of recent clinical or utilization management ... Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on the… more
- St. Luke's University Health Network (Allentown, PA)
- …near vision, visual monotony. EDUCATION: Graduate of an accredited professional nursing program. Registered nurse with current license to practice in the state ... + Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending. + Coordinates RAC … more
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