- RestoraCare Staffing (Houston, TX)
- RestoraCare Staffing is seeking a Registered Nurse (RN) Case Management for a nursing job in Houston, Texas.Job Description & RequirementsSpecialty: Case ... Social Work program. Licenses/Certifications: Current and valid license to practice as a Registered Nurse in the state of Texas or Current and valid license as a… more
- Molina Healthcare (Columbia, SC)
- …Nurse 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 ... for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical… more
- Penn State Health (Hershey, PA)
- …PDF for more detailed steps for assistance._ Indeed.com Sponsored Linked IN Sponsored **Position** Clinical Appeals Nurse ( Clinical Documentation / ... Nurse Licensure Compact. **PREFERRED QUALIFICATION:** + Experience in Clinical Documentation. **WHY PENN STATE HEALTH?** Penn State Health...Clinical Validation Reviews) **Location** US:PA:Hershey | Registered Nurse | Full Time **Req ID**… more
- R1 RCM (Boise, ID)
- As a ** Clinical Coding Appeals Author** , you will help review and interpret medical records to draft appeals of denied and underpaid claims. Every day you ... codes. Then you will draft appeal letters based on clinical judgment and knowledge and making coding change suggestions...with office policy for prioritization + Ensure that all appeals are completed timely and sent by the specified… more
- CVS Health (Hartford, CT)
- …Basic awareness of problem solving and decision making skills Position Summary The Appeals Nurse Consultant position is responsible for processing the medical ... a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,...in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates… more
- Elevance Health (Palo Alto, CA)
- …card, send you a check, or ask you for payment as part of consideration for employment. ** Nurse Appeals CA (US)** + Job Family: MED > Licensed Nurse + Type: ... + CA, PALO ALTO + CA, COSTA MESA **Description** ** Nurse Appeals - California candidates only** **Location: This.../grievances/quality of care issues and is a resource for clinical and non clinical team members in… more
- Kepro (Indianapolis, IN)
- …solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Job Summary: Our ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...Utilization Management Appeals Nurse - LPN/RN will help orchestrate… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management/ Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II… more
- LA Care Health Plan (Los Angeles, CA)
- …(A&G) & General Operations ( Clinical ) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals & Grievances ... to improve the overall appeals & grievance process. Create a best in clinical appeals process that is efficient and effective in managing member appeals… more
- CVS Health (Hartford, CT)
- …residence with occasional rotational weekend and holiday coverage. Position Summary The Appeals Nurse Consultant position is responsible for processing the ... a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,...in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... the safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing… 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, ... of stay, level of care, missing pre-certification, or other clinical reasons and constructing warranted appeals for...possess a demonstrated knowledge of denial management functions. Registered Nurse and a graduate of an accredited school of… more
- CVS Health (Hartford, CT)
- …business hours 8a-5p in time zone of residence Monday - Friday. The Appeals Nurse Consultant position is responsible for processing the medical necessity ... of Medicare appeals for participating providers. Primary duties may include, but...duties may include, but are not limited to: Requesting clinical , research, extrapolating pertinent clinical , applying appropriate… more
- Penn Medicine (Philadelphia, PA)
- …your life's work? Summary: Responsible for coordinating office activities for the Clinical Appeals Coordinators to assist the department in accomplishing the ... the appeal process if appropriate. + Interacts with on-site nurse reviewers to provide required ID badges, Statement of...continuity of communication. + Supports the activities of the Clinical Appeals Coordinator in all phases 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 ... and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES...health plan. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California, Active BLS -… more
- The Cigna Group (Nashville, TN)
- **Cigna Medicare Part C Appeals Reviewer: Appeals Processing Analyst** We will depend on you to communicate some of our most critical information to the correct ... individuals regarding Medicare appeals and related issues, implications and decisions. The ...as well as research and provide a written detailed clinical summary for the Plan Medical Director. + Determine… more
- Universal Health Services (Richmond, VA)
- …https://uhs.com/ The Atlantic Region CBO is seeking a dynamic and talented Clinical Documentation Improvement (CDI) Nurse . The Clinical Documentation ... in this position + At least 5 years of clinical experience in an acute care setting + CCDS...of disease processes and related procedures + Strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes… 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 ... location. The scope of responsibility will be all post-billed denials (inclusive of clinical denials). Serves as part of the Payment Resolution team at an assigned… more
- Centene Corporation (Sacramento, CA)
- …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, ... **Position Purpose:** Manages Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Manages… more
- American Red Cross (Philadelphia, PA)
- …and bard ports. + Act as a consultant to external health care personnel about clinical apheresis. + The American Red Cross will provide all necessary training. + No ... WHAT YOU NEED TO SUCCEED (Minimum Qualifications): + Registered Nurse with current state licensure as required. + A...make a difference by volunteering in a position that appeals to you and allows you to use your… more
