- Evolent (Jefferson City, MO)
- …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 (Jefferson City, MO)
- …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
- Centene Corporation (Jefferson City, MO)
- …**Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more
- Sharecare (Jefferson City, MO)
- …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
- Centene Corporation (Jefferson City, MO)
- …+ Triages and resolves escalated health plan, Claims department, and provider inquires/ appeals or issues + Cross communication with IT, health plans, vendors, and ... a managed care organization preferred. **Certifications:** RN - Registered Nurse or LPN - Licensed Practical Nurse ...Registered Nurse or LPN - Licensed Practical Nurse - State Licensure and/or Compact State Licensure preferred… more