- R1 RCM (Salt Lake City, UT)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help ... basic computer skills is essential for excelling in this remote production-drive position. **Here's what you will experience working...position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** +… more
- Trinity Health (Farmington Hills, MI)
- …and determining root causes of clinical denials. Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, ... patient status, length of stay, level of care, missing pre-certification, or other clinical reasons and constructing warranted appeals for defined populations as… more
- Elevance Health (Knoxville, TN)
- ** Nurse Appeals - Licensed Nurse ** **Location:** This position will work a hybrid model ( remote and office). Ideal candidates will live in the state of ... 50 miles of one of our PulsePoint locations. The ** Nurse Appeals ** is responsible for investigating and...investigations and reviews of member and provider medical necessity appeals . + Investigates member grievances with a clinical… more
- Elevance Health (Costa Mesa, CA)
- ** Nurse Appeals - Licensed Nurse **...Pulse Point. This position will work a hybrid model ( remote and office). Ideal candidates will live in the state ... **Shift:** Monday to Friday from 8:00-5:00 pm PT The ** Nurse Appeals ** is responsible for investigating and.../grievances/quality of care issues and is a resource for clinical and non clinical team members in… more
- Centene Corporation (Sacramento, CA)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... from their home anywhere within the state of California. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing… more
- Trinity Health (Farmington Hills, MI)
- …manner possible: + Coordinates follow-up activities with Utilization Review/Case Management/Coding/ Nurse Liaison to provide required clinical support, as ... Type:** Full time **Shift:** Day Shift **Description:** **POSITION PURPOSE** Work Remote Position (Pay Range: $18. 4663-$27.6994) Performs day-to- day payment… more
- Providence (OR)
- **Description** Providence Health Plan is calling a Clinical Program Coordinator RN who will provide care coordination, case management and care management services ... best people, we must empower them._** **Providence Health Plan is calling a Clinical Program Coordinator RN who will:** + Provide care coordination, case management… more
- Integra Partners (Troy, MI)
- …of UM authorization reviews, both verbally and in writing + Process administrative and clinical appeals and refer as needed to the Medical Director + Maintain ... care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key role in collaborating… 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
- State of Colorado (Denver, CO)
- Registered Nurse I - Marvin Foot Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4428385) Apply Registered Nurse I - Marvin Foot Salary ... shift offered. We have multiple openings. Specific Job Duties: Clinical Duties: Ensures the provision of patient care is...patient care is within standards established by the State Nurse Practice Act and the Division of Youth Services… more
- Sharecare, Inc. (Columbus, OH)
- …available 3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and ... Summary:** The role of the Family Health Advocate is an exciting and innovative remote role newly created to provide meaningful support to members and their families… more
- International Medical Group (Indianapolis, IN)
- …an active RN license in good standing in Indiana. + Location: Hybrid or Remote working options. + Corporate office is in Indianapolis, IN. + Relocation Expenses ... outpatient management of assistance cases. + Knowledge of the Non-certification process and Appeals process including logs and time frames. + Participate in the on… more
- HCA Healthcare (Nashville, TN)
- …plan, and/or hospital setting + A minimum of one-year experience with denials and appeals in a clinical setting preferred + A minimum of one-year experience ... Monday-Friday Day Shift** Introduction Do you have the career opportunities as a Clinical Review Specialist you want with your current employer? We have an exciting… more
- Centene Corporation (Latham, NY)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... + Assist member with filing and resolving complaints and appeals + Direct care to participating network providers +...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
- University of Virginia (Charlottesville, VA)
- …and evaluate complex medical documentation + Demonstrates competence in interpretation of clinical data and the application of UM tools Collaborates with physicians ... consultants and internal UVA UR MD's. + Provides complete accurate and timely clinical data to Insurance companies + Utilizes judgement and critical thinking to… more
- State of Colorado (Denver, CO)
- …health care including physical, psychiatric, and dental maintenance. Job Duties: Clinical Assessment: Detect and prevent the spread of communicable infectious ... complete history. Participate in obtaining data for health program planning. Clinical Diagnosing and Treatment: Diagnose medical problems including emergency medical… more
- State of Colorado (Pueblo, CO)
- …deliver nursing care and therapeutic interventions under the supervision of a registered nurse . The Client Care Aide II (CCA II) provides nursing care, which often ... unit maintenance and security. Duties in this position include: Clinical Skills: + administer nursing care, both psychiatric and...process at the unit level as directed by the Nurse Manager + attends weekly nursing rounds or reads/reviews… more
- State of Colorado (Rifle, CO)
- …Assessment: + Performs both admission and daily assessments during clinical stay, identifying critical stay, identifying critical incidents, emergencies, acute ... and VA regulations. Safety Identification and Intervention: + Monitors the clinical , physical and environmental safety of all residents through assessments and… more
- State of Colorado (Pueblo, CO)
- …deliver nursing care and therapeutic interventions under the supervision of a registered nurse . The Client Care Aide I provides nursing care as assigned and ... on an on-going basis. Duties in this position include: Clinical Skills: + responsible for administering nursing care, both...process at the unit level as directed by the Nurse Manager + attends weekly nursing rounds or read/review… more
- Children's Mercy Kansas City (Kansas City, MO)
- …level of care: + Provide evidence-based clinical guideline and supporting clinical information to support successful appeals of all denials. + Coordinate ... hospital. Overview The BSN, Admission and Denials Care Manager utilizes clinical expertise, insurance knowledge, business know-how, and high level of communication… more