- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes ... regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all applicable State and Federal… more
- Cognizant (Annapolis, MD)
- …cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . ... Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...stand out** . Epic experience . Experience in drafting appeals disputing inpatient clinical validations audits is… more
- Humana (Annapolis, MD)
- **Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals . The Appeals ... independent determination of the appropriate courses of action. The Appeals Nurse 2 reviews documentation and interprets...+ Active unrestricted RN license + 3 years of clinical RN Experience + Appeals nursing experience… more
- Sharecare (Annapolis, MD)
- …available 3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and ... The role of the Family Health Advocate is an exciting and innovative remote role newly created to provide meaningful support to members and their families… more