- Elevance Health (Atlanta, GA)
- ** Nurse Appeals RN - Quality of Care** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and ... Hours:** Monday-Friday, 8:00AM -5:00 PM Eastern Standard Time The ** Nurse Appeals ** is responsible for investigating and...and summarizes medical information for medical director. + Prepares nurse summaries for Quality of Care cases… more
- Elevance Health (Atlanta, GA)
- ** Nurse Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... those hours, including holidays on a rotational basis. The ** Nurse Appeals ** is responsible for investigating and...preferred. + 3 years of clinical experience as a Registered Nurse is strongly preferred. + Experience… more
- Evolent (Atlanta, GA)
- …**Required** + Minimum of 5 years in Utilization Management, health care Appeals , compliance and/or grievances/complaints in a quality improvement environment- ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...part of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of… more
- Humana (Atlanta, GA)
- **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 ... independent determination of the appropriate courses of action. The Appeals Nurse 2 reviews documentation and interprets... RN license + 3 years of clinical RN Experience + Appeals nursing experience +… more
- Molina Healthcare (Atlanta, GA)
- …and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring timely claims payment… more
- Molina Healthcare (Atlanta, GA)
- …hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing ... state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more