- Genmab (Berkeley Heights, NJ)
- …verifications, research of prior authorizations and support through the appeals processEvaluate and refer patients to appropriate financial assistance ... Call CenterCollaborate with PSS Field Teams (Field Reimbursement Managers and Nurse Team) to ensure seamless communication and appropriate handoffs when… more
- Evolent (Trenton, NJ)
- …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 (Trenton, NJ)
- …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
- BelovED Community & Empowerment Academy Charter Sc (Jersey City, NJ)
- …three campuses, an Elementary School, Middle School, and High School. We are hiring a School Nurse to serve all of our students. You will be working on a team of 4 ... Jersey City, Hoboken and New York City. If this appeals to you, then apply today! We have achieved...staff is part of the Pension in New Jersey. Nurse Responsibilities + Carrying out written orders of the… more
- Elevance Health (Morristown, NJ)
- …will make an impact:** + Perform physician-level case review, following initial nurse review, of Medical Oncology regimens and supportive care. + Perform ... physician-level case review, following initial nurse review, of chemotherapy regimens. + Determine medical necessity...a subject matter expert. + Perform first level provider appeals as designated by the client for adverse determinations.… more
- Sharecare (Trenton, NJ)
- …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
- Virtua Health (Mount Laurel, NJ)
- …over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques ... communication with management regarding billing and coding issues including documentation, denials/ appeals , etc.* Follows up on assigned insurances on a monthly… more
- Virtua Health (Mount Laurel, NJ)
- …over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques ... appropriate feedback.exit interviews with external auditors, prepares rebuttals and appeals , take appropriate action with responses (including correcting data and… more
