- Trinity Health (Farmington Hills, MI)
- …and professional behavior. **MINIMUM QUALIFICATIONS** Must possess a demonstrated knowledge of denial management functions. Registered Nurse and a graduate ... Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing… more
- Molina Healthcare (Columbia, SC)
- … who must be licensed in the state you reside. We are looking for a Clinical Nurse Appeals RN to support our SC Health plan (Medicaid and Marketplace). ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB...or health plan. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California,… more
- Providence (Irvine, CA)
- …a provider operational and payer logistical perspective. Works closely with the Clinical Denial RN and support staff to review denied accounts, prepare ... **Description** **Claims Appeals Representative \*Remote * Candidates in AK, WA,...outcomes of follow-up activities. Works closely with the Clinical Denial RN on nuances associated with denials… more