- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & Grievances ... (A&G) & General Operations ( Clinical ) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals & Grievances… more
- CVS Health (Lansing, MI)
- …each and every day. **Position Summary** CVS Aetna is seeking a dedicated ** Appeals Nurse Consultant** to join our remote team. In this role, you will play a ... critical role in ensuring fair and accurate resolution of clinical appeals by applying sound clinical...Occasional weekend and holiday on-call coverage may be required. ** Remote Work Expectations** + This is a 100% … more
- Centene Corporation (Jefferson City, MO)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals...Committee for Quality Assurance (NCQA) standards. This a 100% remote position, working hours will be 9am - 6pm… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview: ;** The Clinical Appeals Reviewer is responsible for processing appeals and ensuring all milestones are met in compliance with regulatory ... a case for determination, interacting directly with providers to obtain additional clinical information, and with members or their advocates to understand the full… more
- Centene Corporation (Trenton, NJ)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... **Must reside within the Eastern Standard Time Zone.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing… more
- CommonSpirit Health (Centennial, CO)
- …to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all ... need the following: Required Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive… more
- LA Care Health Plan (Los Angeles, CA)
- …in Nursing for Registered Nurses Experience Required: At least 8 years of clinical appeals and grievances experience in a managed care, utilization management ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017… more
- Northwell Health (Melville, NY)
- …+ Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect ... retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness… more
- Adecco US, Inc. (Minneapolis, MN)
- Adecco Healthcare & Life Sciences is hiring remote RN Appeals Reviewers! This role is remote / work from home. Please read below and apply with an updated ... days **Pay:** $40.50 to $42.50 an hour **Responsibilities of the RN Appeals Reviewer:** . Responsible for conducting thorough reviews of member and provider… 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 ... our Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have strong organizational… more
- Providence (Beaverton, OR)
- …best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide care ... nearing end of life + Care management services include: nurse education, care coordination and general assistance with managing...care to our members **Providence Health Plan welcomes 100% remote work to residents who reside in the following… more
- Garnet Health (Middletown, NY)
- …rural life, we invite to make your career home with us as a CLinical Documnetaion Specialist on our CDI team at/in Garnet Health Medical Center. Responsibilities ... Under the direction of The Administrator, Coding & Clinical Documentation Improvement and Patient Access, the Manager of...day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate… more
- MD Anderson Cancer Center (Houston, TX)
- …for two years of the five clinical nursing experience. * Preferred: Nurse Defense Audit experience, experience with insurance appeals , prior case management ... and audits of patient accounts to complete Defense Audits. *Ideal Candidate:* A *Registered Nurse (RN)* with experience in * appeals * and * nurse defense… more
- TEKsystems (Orlando, FL)
- …questions addressed. + Verify each review is supported by current clinical citations and references from reputable medical journals/publications. + Ensure content, ... $31.50/hr | LPN: $29/hr Utilization Management (2 Openings) Responsibilities: + Review appeals and all types of Prior Authorizations. + Conduct Admissions reviews… more
- Integra Partners (Troy, MI)
- …of UM authorization reviews, both verbally and in writing + Process administrative and clinical appeals and refer as needed to the Medical Director + Maintain ... care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key role in collaborating… more
- Integra Partners (Troy, MI)
- …criteria (eg, InterQual, CMS, health plan policies). + Review and process clinical and administrative appeals ; coordinate with Medical Director when required. ... The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership...team performance, escalating issues as needed to the UM Clinical Manager. + Ensure compliance with all regulatory, contractual,… more
- State of Colorado (Pueblo, CO)
- Nurse I - RN Critical Incident/Occurrence Reporter-CMHHIP-Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5147450) Apply Nurse I - ... and time listed. + Description + Benefits + Questions Department Information Registered Nurse I-Full Time CMHHIP This position has a residency waiver and will be… more
- State of Colorado (Denver, CO)
- …assigning responsibilities + During specific shifts, functions in the role of Charge Nurse and provides clinical and administrative supervision of nursing staff ... of work, providing clinical leadership and teaching clinical interventions + Functions as the Charge Nurse...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Grand Junction, CO)
- …and private, fenced backyards with recreation equipment. Description of Job The Nurse II provides comprehensive nursing care, clinical assessment, and health ... NURSE II: Grand Junction Regional Center (Western Slope)...and safety through individualized care planning, treatment, documentation, and clinical guidance to direct care staff. Additionally, as a… more
- State of Colorado (Denver, CO)
- Off Hours Nurse Supervisor - Nurse III (Internal Pool) - Colorado Mental Health Hospital Fort Logan Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5132944) Apply Off Hours Nurse Supervisor - Nurse III (Internal Pool) - Colorado Mental Health… more