- Molina Healthcare (Kenosha, WI)
- …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...denied cases in which a formal appeals request has been made or upon request by… more
- Evolent (Madison, WI)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact ... as part of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to… more
- Evolent (Madison, WI)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Molina Healthcare (WI)
- …supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous claims and appeals experience. The candidate must have ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical peers. +… more
- Molina Healthcare (Milwaukee, WI)
- …responsibilities will include specialized medical necessity reviews and/or appeals and supporting market performance. Performance activities include physician ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
- SSM Health (Fond Du Lac, WI)
- …Cancer Center **Worker Type:** Regular **Job Highlights:** We are looking for a infusion nurse in our cancer clinic! Job duties include; 1. Room patients 2. Order ... on IV chemotherapy and oral chemotherapy 7. Be a part of the appeals process 8. Coordinate blood transfusions 9. Phlebotomy coverage 10. Care coordination to… more
- Elevance Health (Waukesha, WI)
- …Director is responsible for collaborating with health plan partners, company nurse practitioners, and an interdisciplinary team to ensure delivery of high-quality ... a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any… more