- 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
- 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
- Blue KC (Kansas City, MO)
- …following areas (eg, medical review, financial, medical analytics, research & adjustment, appeals ) that provided the types and levels of knowledge, skills, and ... (CFE), Accredited Healthcare Fraud Investigator (AHFI) + Medical License: Registered Nurse (RN), Licensed Practical Nurse (LPN), pharmacist, physician **Blue… 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
- Children's Mercy Kansas City (Kansas City, MO)
- …utilizing InterQual and/or MCG screening guidelines, and clinical denials/ appeals oversight. Participates in department and hospital performance improvement ... One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire + One...One of the following: Licensed RN - Kansas, Registered Nurse Multistate License Kansas required upon hire + RN… more