- Humana (Indianapolis, IN)
- **Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals . The Appeals Nurse ... and independent determination of the appropriate courses of action. The Appeals Nurse 2 reviews documentation and interprets data obtained from clinical records… more
- Baylor Scott & White Health (Indianapolis, IN)
- …**SPECIALTY/DEPARTMENT:** Care Management: Case Management Utilization Management Appeals or grievances **SHIFT/SCHEDULE:** Full-time days, Monday-Friday, 8:00 ... vary based on position type and/or level **Job Summary** A Registered Nurse in Nursing Professional Development Generalist role uses expertise to enhance healthcare… more
- CNO Financial Group (Carmel, IN)
- …subject matter expertise in complex cases including claims, billing and appeals issues. Advocates primarily receive incoming requests from members to resolve ... work unusual and VIP cases; initiate and manage claim appeals ; and manage disputes with employer sponsored health plans....cases based on experience. + Collaborating effectively with the Nurse Advocates where a team of Optavise advocates and… more
- Defense Health Agency (Edinburgh, IN)
- …initiation of medical boards for behavioral health conditions, responds to NARSUM appeals , and addresses questions raised on review by the Physical Evaluation Board ... Incumbent responds to inquiries and requests for Independent Medical Reviews (IMR) and appeals ; reviews, researches, analyzes and responds in writing to IMRs and … more