- Evolent (Annapolis, MD)
- …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 (Annapolis, MD)
- …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
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate implementation of the clinical appeal process for members ... Directs the activities and serves as a resource for associates within the Appeals and Grievances Department for Government Programs. We are looking for an… more
- Johns Hopkins University (Baltimore, MD)
- …transplant hepatology to acquire further expertise in these clinical areas. The Nurse Practitioner Fellowship Program also provides a means to help transition the ... nurse practitioner into a career in the specialty of...ongoing care. + Assist with medication prior authorizations and appeals . + Assist MOC with procedure pre-authorizations as needed.… more
- Johns Hopkins University (Baltimore, MD)
- …our ambulatory GI practices located at White Marsh and Bayview. The Nurse Practitioner works collaboratively within a multidisciplinary health team to optimize team ... to patient questions and concerns that a Medical Office Coordinator or nurse cannot answer + Refills urgent prescriptions and/or tracks current prescriptions for… more
- Sharecare (Annapolis, MD)
- …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
- CareFirst (Baltimore, MD)
- …authorization of services and approved claims. + Prepares retrospective reviews, case appeals , billing coordination, and clinical support. + Manages the analysis of ... programs. **Licenses/Certifications Required Upon Hire** : Health Services\RN - Registered Nurse - State Licensure and/or Compact State Licensure. Salary Range:… more
- Johns Hopkins University (Baltimore, MD)
- …has an excellent reputation for training of future nursing leaders and nurse educators, and, among other things, specializes in community public health nursing, ... Giving to coordinate and execute SON's annual giving mailings, including drafting appeals and managing specialty campaigns like the white coat, vital signs, Giving… more
- CVS Health (Annapolis, MD)
- …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