- Denver Health (Denver, CO)
- …in a managed care health insurance plan required . Previous grievance and appeals experience preferred. Licenses : RN-Registered Nurse - DORA - Department of ... Must Be a Colorado Resident Job Summary Under minimal supervision, the Registered Nurse , Grievance & Appeals is responsible for assessing and completing… more
- The Emily Program (Atlanta, GA)
- …our clients at all levels of care. Position Overview The Psychiatric Nurse Practitioner is responsible for conducting psychiatric assessments and providing treatment ... 30346 Take a Virtual Tour of our Atlanta Site How Psychiatric Nurse Practitioners Empower Recovery Provide direct psychiatric services through the comprehensive… more
- DaVita, Inc. (Conyers, GA)
- …think over when speaking with our team: Why working with dialysis patients appeals to you (opportunity to develop relationships, etc.) Your thoughts on teamwork ... working in a fast-paced environment DaVita is seeking a Nurse who is looking to give life in an...Headspace(R), backup child and elder care, maternity/paternity leave, pet insurance , and more Paid training Requirements: Associates Degree in… more
- AltaMed Health Services Corporation (Montebello, CA)
- …forward every day. Job Overview The Quality Specialist is a California licensed nurse responsible for collecting, analyzing, and mining quality data metrics, as per ... all managed care activities (eg, UM, CM, Claims, Member Services, Appeals and Grievances, Credentialing, Provider Network) tracks and trends specified… more
- MLee Healthcare Staffing and Recruiting, Inc (Granger, IA)
- Registered Nurse - Med / Surg & Emergency Room Great Benefits / Competitive Salary / Full Time We are seeking a highly motivated and compassionate Registered ... Nurse to join our growing team in Iowa. This...schooling, and year-round community-based activities are among the many appeals to this position. Qualifications: Graduate from an accredited… more
- MLee Healthcare Staffing and Recruiting, Inc (Greenfield, IA)
- Registered Nurse - Med / Surg & Emergency Services Great Benefits / Competitive Salary / Full Time This location offers plenty for a true nature lover with stunning ... good schooling, and year-round community-based activities are among the many appeals to this position. Qualifications: Graduate from an accredited school of… more
- Rasmussen University (Minneapolis, MN)
- Dean of Nursing and Nurse Administrator Rasmussen University Brooklyn Park, MN The Dean of Nursing & Administrator serves as the nurse leader for the nursing ... partners, the healthcare community, and other relevant constituencies. Process SAP appeals in conjunction with a student advisor; responsible for making… more
- Pioneer Healthcare (Indianapolis, IN)
- …and other healthcare professionals to ensure continuity of care. Coordinate insurance authorizations, appeals , and approvals for necessary medical services ... Manager Job Description: If you want to make a significant impact as a Registered Nurse - Case Manager in Indianapolis, IN this position might be what you are… more
- Wealthy Group of Companies LLC (Overland Park, KS)
- …identifycost-saving opportunities, secure funding through grants orcommercial insurance reimbursements (no Medicare/Medicaid), ensurecompliance with federal and ... direct oversight of the ClinicalDirector, Director of Nursing, staff Nurse Practitioners, andFacilities Director, while leading and mentoring a multidisciplinaryteam… more
- Pioneer Healthcare (Salinas, CA)
- …and other healthcare professionals to ensure continuity of care. Coordinate insurance authorizations, appeals , and approvals for necessary medical services ... Salinas, CA Job Description: If you want to make a significant impact as a Registered Nurse - Case Manager in Salinas, CA this position might be what you are looking… more
- HC&N Healthcare Solutions (West Palm Beach, FL)
- …(Managed Medicare, Managed Medicaid and Commercial) concurrent reviews Initiate and track insurance appeals for admission denials and continued stay Schedule UAS ... team All other duties as assigned Requirements/Qualifications: Current FL Licensed Registered Nurse MDS experience required and a working knowledge of Insurance … more
- Amber Specialty Pharmacy (Omaha, NE)
- … appeals , grant funding, clinical) Works with the pharmacist and/or nurse to contact providers and insurance companies to verify prescriptions, ... Primary Responsibilities: Acts as a liaison between specialty pharmacy, patients, insurance companies, Pharma manufacturer and providers offices via phone, fax,… more
- Corewell Health (Royal Oak, MI)
- …when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization for care and ... care management, utilization review, home care and/or discharge planning. Preferred Registered Nurse (RN) - State of Michigan License Upon Hire required Basic Life… more
- AndHealth (Indianapolis, IN)
- …verification and assist with identifying appropriate secondary coverage. Complete insurance verification and medication coverage determinations, and work with ... formulary restrictions. Assist with the completion of prior authorizations or appeals necessary to ensure medication access for patients. Regularly contact or… more
- BioSpace (Detroit, MI)
- …Must be able to effectively collaborate across all corporate functions-MSLs, TLLs, Nurse Coordinators, Field Access Team, supporting sales teams, etc. Key account ... policies and processes (eligibility and benefit verification, prior-authorization and appeals /denials) Improve use of marketing resources to maintain and develop… more
- Mount Sinai Health System (New York, NY)
- …appeals , On / Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in ... work as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials +… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound clinical judgement to ... integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a...comprehensive package of benefits including paid time off, medical/dental/vision insurance , 401(k), and a suite of well-being benefits to… more
- Elevance Health (Tampa, FL)
- ** Nurse Appeals - Medicare** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... an accommodation is granted as required by law. The ** Nurse Appeals - Medicare** is responsible for...term disability benefits, 401(k) +match, stock purchase plan, life insurance , wellness programs and financial education resources, to name… more
- Molina Healthcare (Midvale, UT)
- …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously ... _For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...internet connectivity of high speed required._ **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical… more
- St. Luke's University Health Network (Allentown, PA)
- …a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... APR-DRG for the purpose of appealing proposed DRG and coding changes by insurance providers or their respective auditors JOB DUTIES AND RESPONSIBILITIES: + Conduct… more
