- Centene Corporation (Topeka, KS)
- …analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters ... for member and provider clinical appeals and ensure letters are compliant...departments and agencies **Education/Experience:** RN with 4+ years of clinical nursing and/or case management experience or LPN/ LVN… more
- Centene Corporation (Atlanta, GA)
- …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. **Centene is Hiring: Clinical Review Clinicians - Appeals (Ambetter Market)**...Licensed Practical Nurse - State Licensure required or + LVN - Licensed Vocational Nurse required or + RN… more
- Molina Healthcare (Tacoma, WA)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within ... compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical reviews of previously denied cases in which… more
- Centene Corporation (New York, NY)
- …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...Licensed Practical Nurse - State Licensure required or + LVN - Licensed Vocational Nurse required or + RN… more
- Evolent (Cheyenne, WY)
- …adjudication of processed appeals . **What You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review as an LPN or ... for the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact as part… more
- Molina Healthcare (Long Beach, CA)
- …Delegation Oversight Manager with additional duties of the team. We are looking for LVN 's with at least 4 years of UM experience, NCQA accreditation, and knowledge ... in this role. Productivity is important with quick turnaround times. Experience with Appeals , Auditing, and Compliance /Quality will be a good fit for this position.… more
- Bakersfield Behavioral Healthcare Hospital (Bakersfield, CA)
- …of the Utilization Review Specialist is to review medical records and prepare clinical appeals (when appropriate) on medical necessity, level of care, length ... requirements for the position such as a High School Diploma and a current California LVN License we're really looking for people who bring their HEART to work. If… more
- ManpowerGroup (Columbia, SC)
- …an Accredited School of Licensed Practical Nursing (LPN) or Licensed Vocational Nursing ( LVN ). **Experience:** + Minimum **2 years of clinical experience** in a ... eligibility and medical necessity of services. + Handle first-level appeals , ensuring detailed documentation of determinations. ✔ **Education & Communication… more