- R1 RCM (Boise, ID)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Nurse ** , you will help our hospital clients by ... production-driven position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical records and… more
- R1 RCM (Boise, ID)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid… more
- Prime Therapeutics (Boise, ID)
- …and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing ... web-based application and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings and consults with management on regular… more
- Sharecare, Inc. (Boise, ID)
- …or assist member in working with payer to complete prior authorization or appeals process, when necessary. + Abide by Clinical Advocacy Program Description and ... patient and provider outcomes **Qualifications:** + Current multi-state/compact Registered Nurse licensure in state of residence is required, with ability… more
- Sharecare, Inc. (Boise, ID)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Sedgwick (Boise, ID)
- …client or facility to obtain additional or missing information. + Handles provider appeals as appropriate to fee schedule and contractual disputes. + Identifies and ... review experience in multi-state jurisdiction; prior experience in PPO provider appeals , re-pricing, surgery review, by report and RNE review; two (2)… more