- Stanford Health Care (Palo Alto, CA)
- …role in the Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and denials. This position ... regulations, payor policies, and industry best practices related to clinical appeals and denials management. Evaluate internal...Spec required within 180 Days + RN - Registered Nurse - State Licensure And/Or Compact State Licensure required… more
- PharmaCord (Jeffersonville, IN)
- …closure to include; benefit investigations, prior authorizations / denial appeals , determining financial qualifications for assistance programs and assisting ... to follow up on proper submission and/or outcome Coordinates nurse teach with field-based nurse educators, as...eligible for a hybrid schedule (50% in office, 50% remote ). To qualify for a hybrid schedule, you are… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes ... regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all applicable State and Federal… more
- Cognizant (Washington, DC)
- …cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . ... Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...stand out** . Epic experience . Experience in drafting appeals disputing inpatient clinical validations audits is… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & Grievances ... (A&G) & General Operations ( Clinical ) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals & Grievances… more
- CVS Health (Columbus, OH)
- …Management (UM) Nurse to join our remote team. **Position Summary** The Appeals Nurse Consultant plays a key role in resolving clinical complaints ... appeals by reviewing medical records and applying clinical guidelines for Utilization Management group. This RN must...clinical resolutions with internal and external support areas. ** Remote Work Expectations** + This is a 100% … more
- Humana (St. Paul, MN)
- **Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals . The Appeals ... independent determination of the appropriate courses of action. The Appeals Nurse 2 reviews documentation and interprets...+ Active unrestricted RN license + 3 years of clinical RN Experience + Appeals nursing experience… more
- Centene Corporation (New York, NY)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... license.** **Hours: 8:30am-5pm EST Monday - Friday.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview: ;** The Clinical Appeals Reviewer is responsible for processing appeals and ensuring all milestones are met in compliance with regulatory ... a case for determination, interacting directly with providers to obtain additional clinical information, and with members or their advocates to understand the full… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all ... need the following: Required Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive… more
- Nuvance Health (Danbury, CT)
- *Description* *FULL TIME DAY SHIFTS- VARIABLE HOURS / WEEKEND ROTATIONS REQUIRED* * *Hybrid/ Remote * * *Summary:* The purpose of the Denial Prevention Nurse is to ... in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and Blue Shield of Minnesota Position Title: Care Manager PreService & Retrospective - Appeals Location: Remote Career Area: Health Services About Blue Cross and ... unspecified code and modifier code reviews. Your Responsibilities * Applies clinical experience, health plan benefit structure and claims payment knowledge to… more
- State of Colorado (Grand Junction, CO)
- Clinical Nurse Trainer ( NURSE III) -...employment start date. + Travel - Position must travel to remote work sites and must utilize a state vehicle, if ... Junction Regional Center (WESTERN SLOPE) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5115456) Apply Clinical Nurse Trainer ( NURSE III)… more
- Molina Healthcare (Albuquerque, NM)
- …resource for utilization management, chief medical officers, physicians and member/provider inquiries/ appeals . * Provides training and support to clinical peers. ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities....of CPT/HCPCS codes, record review, chart audit, provider disputes, appeals , and 1500 & UB04 claim experience are highly… more
- Providence (Beaverton, OR)
- …best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide care ... nearing end of life + Care management services include: nurse education, care coordination and general assistance with managing...care to our members **Providence Health Plan welcomes 100% remote work to residents who reside in the following… more
- Garnet Health (Middletown, NY)
- …rural life, we invite to make your career home with us as a CLinical Documnetaion Specialist on our CDI team at/in Garnet Health Medical Center. Responsibilities ... Under the direction of The Administrator, Coding & Clinical Documentation Improvement and Patient Access, the Manager of...day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate… more
- State of Colorado (Denver, CO)
- …assigning responsibilities + During specific shifts, functions in the role of Charge Nurse and provides clinical and administrative supervision of nursing staff ... of work, providing clinical leadership and teaching clinical interventions + Functions as the Charge Nurse...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Integra Partners (Troy, MI)
- …criteria (eg, InterQual, CMS, health plan policies). + Review and process clinical and administrative appeals ; coordinate with Medical Director when required. ... The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership...team performance, escalating issues as needed to the UM Clinical Manager. + Ensure compliance with all regulatory, contractual,… more
- State of Colorado (Pueblo, CO)
- Nurse I - Registered Nurse I...This position is responsible for assisting nursing staff with clinical direction of nursing staff, QA/PI activities and to ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5101894) Apply Nurse I - Registered Nurse I - CMHHIP Salary $43.80 - $61.31 Hourly Location… more
- State of Colorado (Pueblo, CO)
- Registered Nurse II- CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5101960) Apply Registered Nurse II- CMHHIP Salary $45.99 - ... and time listed. + Description + Benefits + Questions Department Information Registered Nurse II-Full Time CMHHIP This posting will be used to fill multiple… more
