- Christus Health (Bellaire, TX)
- …liaison and point of contact for clinical denials and appeal inquiries. The Clinical Appeals Nurse will review each case identified/referred for appeal based on ... viability of the appeal, and manage the appeal process. The Clinical Appeals Nurse is responsible for appealing all inappropriate denials through all possible… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals ...and execute on strategic opportunities to improve the overall appeals & grievance process. Create a best in ... + Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted… more
- AmeriHealth Caritas (Philadelphia, PA)
- …preferably within a managed care organization **Licensure:** + Current and unrestricted Registered Nurse (RN) licensure or compact state licensure **Skills & ... **Role Overview: ;** The Clinical Appeals Reviewer is responsible for processing appeals...Committee Quality Assurance (NCQA) standards related to appeal and grievance operations **Education & Experience:** + Bachelor's degree (BSN)… more
- Fallon Health (Worcester, MA)
- …Degree in nursing, or equivalent. **License:** Active and unrestricted licensure as a Registered Nurse in Massachusetts. **Experience:** Three to five years of ... and LinkedIn. **Brief summary of purpose:** The Fallon Health Appeals and Grievance process is an essential...expectations. Under the direction of the Director, the Appeal Nurse represents, manages and oversees second level appeal cases… more
