- Evolent (Providence, RI)
- …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
- Cognizant (Providence, RI)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Charter Care Health Partners (Providence, RI)
- Summary: The Clinical Appeals - Author performs appeals and denials management and represents the hospital where claims were denied by either governmental ... duties as required. Education/Licensure: Medical Graduate, Physician Assistant or Registered Nurse (Current RI License) Experience: + Knowledge of third-party payer… more
- Fallon Health (Worcester, MA)
- …Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The Fallon Health Appeals and Grievance process is an essential function to Fallon Health's compliance ... and member expectations. Under the direction of the Director, the Appeal Nurse represents, manages and oversees second level appeal cases (Office of Medicaid,… more
- Sharecare (Providence, RI)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Fallon Health (Worcester, MA)
- …authorization information in QNXT because of determinations made by Authorization Coordinators, Nurse Reviewers and/or Nurse Care Specialists. + Handles an ... contract information, benefits, etc.), including authorization details when requested for appeals . + Distributes departmental facsimiles; checks Right Fax no less… more