- Actalent (Dayton, OH)
- …in the state of Ohio. * Must have at least 1 year of Clinical Appeals experience. * Associate degree or equivalent years of relevant experience required. * ... We are currently hiring for a Clinical Appeals Nurse in a fully REMOTE role! A...or turn into something more long-term. Description: The Clinical Appeals Nurse is responsible for the completion of clinical… more
- CVS Health (Hartford, CT)
- …experience Preferred Qualifications + Utilization Review experience + Medicare experience + Appeals experience Education + Associate 's Degree or RN diploma ... with occasional rotational weekend and holiday coverage. Position Summary The Appeals Nurse Consultant position is responsible for processing the medical necessity… more
- Apex Health Solutions (Houston, TX)
- …is focused on the processing of customer and provider Medicare and Commercial appeals and grievances. This associate may screen incoming complaints, process ... Job Title: Appeals & Grievances Coordinator Department: Appeals and Grievances Supervisor: Manager, Appeals & Grievances FLSA Status: Nonexempt Summary The … more
- Equal Employment Opportunity Commission (Washington, DC)
- …Director of Appellate Review Programs (ARP) manages the EEOC's national federal sector appeals program. The Associate Director position is designated as SES, ... and long-range planning and policy development for the agency's administrative appeals program; determines program priorities; and revises and ensures the legal… more
- Actalent (Dayton, OH)
- We are hiring for a Clinical Appeals Nurse (RN). This is a fully remote role for someone who is licensed in Ohio! Description: Job Summary: The Clinical Appeals ... Nurse is responsible for the completion of clinical appeals and state hearings from all states. Essential Functions: * Responsible for the completion of clinical … more
- Universal Health Services (Reno, NV)
- …Job Summary: Under the direction of the Manager of Operations, the Appeals Specialist is responsible for ensuring the appropriate review, research, processing and ... responding to written member and provider complaints, appeals , and grievances. This position is required to apply analytical and critical thinking when reviewing… more
- Elevance Health (Cincinnati, OH)
- **Grievance/ Appeals Analyst Lead** **Must be located within 50 miles of a PulsePoint office** **This position is primarily work from home but requires working in a ... local office once per quarter** The **Grievance/ Appeals Analyst Lead** is responsible for leading and coaching a team of Grievance & Appeals Analysts in the… more
- Magellan Health Services (Boise, ID)
- Coordinates appeals process as assigned, attends to risk management issues associated with case management and processes appeal requests. In some cases may be ... medical necessity reviews. + Enters all data related to appeals and case reviews into a database. + Prepares...Education - Required GED, High School Education - Preferred Associate License and Certifications - Required License and Certifications… more
- CVS Health (Hartford, CT)
- …residence. Position OverviewAdministers review and resolution of clinical complaints and appeals . Interprets data obtained from clinical records to apply appropriate ... class policies, plans, and procedures in support of the Appeals area objectives. + Executes review of all clinical...+ Exceptional verbal and written communication skills Education + Associate 's Degree or RN diploma required Pay Range The… more
- State of Minnesota (St. Paul, MN)
- **Working Title: Appeals Paralegal** **Job Class: Paralegal** **Agency: Human Services Dept** + **Who May Apply** : Open to all qualified job seekers + **Date ... AFSCME + **Division/Unit** : DHS - Central Office / Appeals Paralegal Supv + **Work Shift** : Day Shift...an accredited program which resulted in a program certificate, associate degree, bachelor's degree or post bachelor's degree; OR… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Grievance and Appeals Coordinator 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #660 Friday, May 3, 2024 Centers Plan for Healthy Living's goal is to create ... healthy living. JOB SUMMARY: As an integral part of the Grievance and Appeals (G&A) Department, the G&A Coordinator lends their support in processing member-related… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting… more
- Centene Corporation (Phoenix, AZ)
- …and scanning incoming mail **Education/Experience:** High school diploma or equivalent. Associate 's degree preferred. 2+ years grievance or appeals , claims ... **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… 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, 90017 ... safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the… more
- State of Minnesota (St. Paul, MN)
- **Working Title: Appeals Officer** **Job Class: Revenue Tax Specialist Senior** **Agency: Revenue Department** + **Job ID** : 76360 + **Location** : St. Paul + ... Revenue Dept / Revenue (inc Assessors)-MAPE + **Division/Unit** : Appeals & Legal Services / Appeals 2...the agency may substitute for experience as follows: An associate degree may substitute for 6 months of experience.… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct… more
- University of Virginia (Charlottesville, VA)
- Coordinates complex appeals for denied claims and retro authorization appeals . Coordinates with third party vendors for additional appeal support. Provides ... appeals support for status of accounts that have been...Compensation Range: $22.39 - $35.82 Hourly **MINIMUM REQUIREMENTS** **Education:** Associate degree required. **Experience:** 5 years of Revenue Cycle… more
- Trinity Health (Farmington Hills, MI)
- …as part of the payment resolution team that receives, analyzes, and appeals denials received for an assigned PBS location. Reviews, researches and resolves ... knowledge of state/federal laws as they relate to contracts and the appeals process. Investigates and addresses overpayment and underpayment accounts with the… more
- Humana (Columbus, OH)
- …Medical Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart… more
- State of Indiana (Indianapolis, IN)
- Appeals Operations Director Date Posted: Apr 25, 2024...Degree and 7+ years of experience, or + an Associate 's Degree and 9+ years of experience, or + ... at least 11+ years of experience applying the below, outlined knowledge, skills, and abilities in a similar role. You must meet the following requirements to be considered for employment: + Mastery knowledge in program subject matter obtained through… more