- Bluestone Child & Adolescent Psychiatric Hospital (University Heights, OH)
- Psychiatric Intake Nurse - FT Nights, 5-8 hour shifts- Sunday through Thursday BENEFITS: At Bluestone, we prioritize our employees and their wellbeing. We provide ... skills. Experience: A minimum of 1 year experience as a psychiatric nurse . 1-2 years-experience in behavioral health utilization review preferred. AGENCY SUMMARY:… more
- Lee Health (Fort Myers, FL)
- …a unique blend of natural beauty, a warm climate, and a relaxed lifestyle that appeals to many people. Florida also benefits from no state income tax, which can make ... by the American Nurses Association and in accordance with the Florida Nurse Practice Act. Requirements Education Requirements: Baccalaureate Degree in Nursing (BSN)… more
- Unknown (Reno, NV)
- …in nursing programs, and 2 years of direct patient care as a registered nurse are required. The ideal candidate will have a current RN license, experience in ... role also demands a commitment to diversity, the ability to manage student appeals and grievances, and a proactive approach to maintaining the quality of instruction… more
- Unknown (Reno, NV)
- …position, teaching in nursing programs, and direct patient care as a registered nurse . The role requires a current RN license, experience in supervision, planning, ... teamwork. Responsibilities also include maintaining community relationships, managing student appeals and grievances, and ensuring that students are properly… more
- Unknown (Boise, ID)
- …nursing programs, and 2 years of direct patient care as a registered nurse . The role requires strong leadership, communication, and organizational skills, as well as ... and strategic planning. Responsibilities also include student advising, managing academic appeals , and ensuring that students meet the necessary requirements for… more
- Unknown (Boise, ID)
- …in nursing programs, and 2 years of direct patient care as a registered nurse are required. The ideal candidate will have a strong leadership style, excellent ... overseeing the admission process, writing articulation agreements, and managing student appeals and grievances. The role demands a proactive individual who can… more
- Healthkeeperz, Inc. (Asheville, NC)
- …Persons (LRP) about care teams, services, rights, the grievance and appeals process, available service options, and payer requirements. . Promote customer ... nursing or another relevant human services area, or licensure as a registered nurse (RN) . Two years of experience working directly with individuals with behavioral… more
- MVP Health Care (Tarrytown, NY)
- …Qualifications you'll bring: Current New York State Licensure as a Registered Nurse required. Certification in Case Management required within 24 months after hire. ... to maintain cost-effectiveness and manage Medical Loss Ratio (MLR). Appeals & Denials: Participate in the appeals ...(MLR). Appeals & Denials: Participate in the appeals process for denied services and ensure timely resolution.… more
- CVS Health (Lansing, MI)
- …with heart, each and every day. **Position Summary** CVS Aetna is seeking a dedicated ** Appeals Nurse Consultant** to join our remote team. In this role, you ... a critical role in ensuring fair and accurate resolution of clinical appeals by applying sound clinical judgment and regulatory knowledge. **Key Responsibilities** +… more
- Elevance Health (Cleveland, OH)
- ** Nurse Appeals -Licensed Nurse ** **Location** : Ohio, candidates must be residents of Ohio to be considered. **Hybrid 1** : This role requires associates to ... will be necessary and is dependent on court hearing schedules. The Nurse Appeals is responsible for investigating and processing and medical necessity appeals… more
- Elevance Health (Tampa, FL)
- ** Nurse Appeals ** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... employment, unless an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- Elevance Health (Columbus, OH)
- ** Nurse Appeals RN** **Location** : Ohio-Cincinnati, Columbus, Mason, or Seven Fields _(Must be within commutable distance to the listed locations.)_ ... employment, unless an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... the safety net required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily… more
- Dignity Health (Rancho Cordova, CA)
- …and maintaining patient confidentiality (HIPAA) are also essential. Ultimately, the Appeals and Grievances Nurse monitors denial trends, recommends corrective ... **Job Summary and Responsibilities** The Appeals and Grievances LVN is a critical role...relevant documentation is presented to the Medical Director. The nurse must meticulously track and document all appeal activities,… more
- Corewell Health (Grand Rapids, MI)
- …all components of insurance prior authorizations, initial reviews, continuous stay reviews and appeals . Nurse Care Manager - Plans and prioritizes care for ... admission waiting list, insurance prior authorizations, continuous stay reviews and appeals . Additional support to the UM functions of the Corewell Health… more
- MD Anderson Cancer Center (Houston, TX)
- …and audits of patient accounts to complete Defense Audits. *Ideal Candidate:* A *Registered Nurse (RN)* with experience in * appeals * and * nurse defense ... degree for two years of the five clinical nursing experience. * Preferred: Nurse Defense Audit experience, experience with insurance appeals , prior case… more
- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and electronic ... format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible to develop a… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate implementation of the clinical appeal process for members ... serves as a resource for associates within the Clinical Appeals and Analysis unit. We are looking for an...performance as needed. **Licenses/Certifications** : + RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon… more
- Molina Healthcare (NE)
- …Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory ... and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have strong organizational skills, proficient… more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with the development of a… more
