- Elevance Health (Olathe, KS)
- Nurse Appeals **Location:** This position will work a hybrid model (remote and office). Candidates must reside in Olathe, KS, Topeka, KS, or Overland Park, KS. ... The Nurse Appeals role is responsible for investigating and processing and medical necessity appeals requests from members and providers. **How you will make… more
- Prime Therapeutics (Topeka, KS)
- …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
- Ascension Health (Manhattan, KS)
- …related to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals . + Assess and coordinate discharge planning needs with ... **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Kansas Board of Nursing required. Education:… more
- Sharecare, Inc. (Topeka, KS)
- …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. (Topeka, KS)
- …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 (Topeka, KS)
- …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