- Cognizant (Washington, DC)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and… 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 ...High School Diploma or GED **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate implementation of the clinical appeal process for ... and serves as a resource for associates within the Clinical Appeals and Analysis unit. We are...team-based performance as needed. **Licenses/Certifications** : + RN - Registered Nurse - State Licensure And/or Compact… more
- Johns Hopkins University (Baltimore, MD)
- …division in fulfilling its mission. **Minimum Qualifications** + Master's Degree in Nursing; Registered Nurse license and Certified as a Nurse Practitioner. ... our ambulatory GI practices located at White Marsh and Bayview. The Nurse Practitioner works collaboratively within a multidisciplinary health team to optimize team… more
- CVS Health (Annapolis, MD)
- …licensure in non-compact states as needed. + 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of ... and other key stakeholders such as Medical Directors, account teams/ clinical liaisons, etc.) to ensure consistency in clinical... Appeals experience in Utilization Management + Must have experience… more
- CareFirst (Baltimore, MD)
- …Office programs. **Licenses/Certifications Required Upon Hire** : Health Services\RN - Registered Nurse - State Licensure and/or Compact State Licensure. ... authorization of services and approved claims. + Prepares retrospective reviews, case appeals , billing coordination, and clinical support. + Manages the analysis… more