- Molina Healthcare (Orlando, FL)
- … 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
- AdventHealth (Altamonte Springs, FL)
- …role you will contribute:** The role of the Utilization Management (UM) Registered Nurse ( RN ) is to use clinical expertise by analyzing patient records ... admission, treatment, and appropriate level of care. The UM RN utilizes key clinical data points to.... Current and valid license to practice as a Registered Nurse (ADN or BSN) required. .… more
- AdventHealth (Altamonte Springs, FL)
- …expertise and experiences you'll need to succeed:** . Bachelor's . 1 Related Experience . Registered Nurse ( RN ) . Extensive understanding of CPT, HCPCS, ICD, ... and appealing post-remit denials for all Inpatient and Outpatient clinical services across the system, as well as review...obtain further patient information to be used in the appeals process if necessary. + Provide reports, education, and… more