- Elevance Health (Chicago, IL)
- ** Appeals Nurse Reviewer I**...Outreach to providers with appeal process instructions. + Clinical review for the RBM and Surgical solution on a ... set of clinical domains, including radiology, cardiology and oncology. The ** Appeals Nurse Reviewer I** is responsible for conducting preauthorization, out… more
- Cognizant (Springfield, IL)
- …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
- CVS Health (IL)
- …in accordance with contract. Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) ... Aetna's Law Document Center regarding litigation; lawsuits. Handles extensive file review requests. Assists in preparation of complaint trend reports. Assists in… more
- CVS Health (IL)
- …with other key business areas. + May develop/assist in development and/ review new training content. + May collaborate/deliver inter and intra-departmental training ... + 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience +...years of Utilization Management experience + 3+ year(s) of Appeals experience in Utilization Management + Must have experience… more