- Evolent (Little Rock, AR)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Cognizant (Little Rock, AR)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Banner Health (AR)
- …on team members to ensure quality reviews of payer denials and/or appeals . Accurately and thoroughly completes documentation required for claims payment of services ... team members and physicians for problem-solving on various denials and/or appeals related patient services, processes, and specific denial issues. Identifies… more
- Sharecare (Little Rock, AR)
- …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
- Centene Corporation (Little Rock, AR)
- …Systems), HOS (Health Outcomes Survey), CTMs (Complaints to Medicare), Disenrollments, Appeals , and Grievances. + Collaborates with Provider Relations and other ... Driver's License required. Pharmacy Technician, Medical Assistant Licensed Vocational Nurse , Licensed Practical Nurse , Social Work licensure preferred.… more
- CVS Health (Little Rock, AR)
- …in non-compact states as needed. + 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of Appeals ... experience in Utilization Management + Must have experience using MS Office + Must be willing to work holiday rotation annually, up to 2 per year + Utilization Management work schedules will include weekends, holidays, and evening hours rotation. **Preferred… more