- UNC Health (Chapel Hill, NC)
- …communities we serve.RN Utilization Manager position specifically for a Utilization Manager/Clinical Appeals Nurse . This person is based at the Hedrick building ... UNC Health is seeking a Registered Nurse (RN) Care Manager for a nursing job...employment date.Licensure/Certification Requirements:* Licensed to practice as a Registered Nurse in the state of North Carolina.Professional Experience Requirements:*… more
- The University of Vermont Health Network (Elizabethtown, NY)
- …employee health documents and reports. The manager is a registered professional nurse manager who is responsible for conducting inpatient Care Management; and Swing ... in nursing field. BSN preferred.* Must be a Registered Nurse (RN), licensed in good standing in NYS. Must...quality issues related to utilization management with application for appeals and denials management. * Knowledge of team/small group… more
- Elevance Health (Hendersonville, TN)
- ** Nurse Appeals - Licensed Nurse ** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live in the state of ... Louisiana within 50 miles of one of our PulsePoint locations. The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- Elevance Health (Rancho Cordova, CA)
- ** Nurse Appeals - Licensed RN Nurse ** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live in the state of ... locations. **Shift:** Monday to Friday from 8:00-5:00 pm PT The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical quality oversite. ... DME, and Complex Care Needs. Essential Qualifications + Current licensed Registered Nurse (RN) with state licensure. Must retain active and unrestricted licensure… more
- Kepro (Indianapolis, IN)
- …solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Job Summary: Our ... Utilization Management Appeals Nurse - LPN/RN will help orchestrate the seamless resolution of appeals in line with health regulations. He or She will… more
- Molina Healthcare (TX)
- …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 REGISTERED NURSE (RN) with prior experience in Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
- CVS Health (Hartford, CT)
- …position are Monday-Friday 8a-5p in time zone of residence. Position Summary The Appeals Nurse Consultant position is responsible for processing the medical ... necessity of Medicare Part C appeals from both members and providers. This role is...a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,… more
- R1 RCM (Salt Lake City, UT)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid… more
- CVS Health (Hartford, CT)
- …telework position. Hours for this role are Monday-Friday 8a-5p. Position Summary The Appeals Nurse Consultant position is responsible for processing the medical ... necessity of Medicare Part C appeals from both members and providers. This role is...a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,… more
- Universal Health Services (Richmond, VA)
- …CBO is seeking a dynamic and talented Clinical Documentation Improvement (CDI) Nurse . The Clinical Documentation Improvement (CDI) Nurse provides clinically ... based concurrent and retrospective review of inpatient medical records to evaluate the utilization and documentation of acute care services. The goal of concurrent review includes facilitation of appropriate physician documentation of care delivered to… more
- Motion Recruitment Partners (Durham, NC)
- Clinical Appeals Analyst Durham, NC **100% Remote** Contract $35/hr - $39/hr Our client, a nationally recognized and award-winning company in the health insurance ... a possible contract to hire opening for a Clinical Appeals Analyst. They have over 4 million customers and...Duration: 6+ Months **Required Skills & Experience** + Registered Nurse in the state of North Carolina with 3… more
- Penn Medicine (Bala Cynwyd, PA)
- …UPHS areas. + Direct supervision of hospital Compliance Analysts, Senior Compliance Analyst, Nurse Auditor, and Analyst Government Audits and Appeals + Recruit ... 8:30AM -5:00PM The Director for Hospital Billing Compliance and Government Audits/ Appeals directs the planning, coordinating, scheduling and performance of annual… 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
- Centene Corporation (Columbus, OH)
- …Ohio **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more
- Trinity Health (Farmington Hills, MI)
- …Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing ... of appeals as required by payers, in addition to promoting...possess a demonstrated knowledge of denial management functions. Registered Nurse and a graduate of an accredited school of… more
- CareFirst (Baltimore, MD)
- …of the Clinical Medical Claims Review, Medical Underwriting, Medical Policy, Clinical Appeals and Analysis programs and Quality of Care Complaint Unit. May lead ... that week. **ESSENTIAL FUNCTIONS:** + Directs the Medical Review and Appeals units and manages multiple strategic clinical projects that span organizational… more
- Rush Copley Medical Center (Aurora, IL)
- **Position Summary** : The Appeals Specialist RN reviews inpatient hospital denials, clinical validation requests, and upheld denials after physician-to-physician ... (P2P) discussions then conducts appeals , as appropriate. Monitors and tracks denial outcomes with...focus on Resolute Hospital Billing. **POSITION REQUIREMENTS** **License:** Registered Nurse (RN) in the State of IL with at… more
- Penn Medicine (Philadelphia, PA)
- …work? **Summary:** Responsible for coordinating office activities for the Clinical Appeals Coordinators to assist the department in accomplishing the goals and ... also follow expected timelines for Federal and State audits and appeals . **Responsibilities:** + Demonstrates Professionalism within the framework of Relationship… 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
