- Molina Healthcare (OH)
- … decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- Evolent (Columbus, OH)
- …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- Molina Healthcare (Cincinnati, OH)
- …resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical ... state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- Medical Mutual of Ohio (OH)
- …+ Current, unrestricted license in the state of Ohio in one of the following: Registered Nurse ( RN ), Licensed Practical Nurse (LPN), Licensed Independent ... management on implementation plans. Develops, delivers and evaluates cross-functional clinical , non- clinical , and systems training; new employee orientation;… more
- Elevance Health (Independence, OH)
- …provide an equivalent background. Preferred Skills, Capabilities and Experiences: + Licensed Registered Nurse ( RN ) or Licensed Independent Social Worker ... you make an impact:** + Accountable for implementing and overseeing clinical management functions for members receiving LTSS, including assessments, service… more