- R1 RCM (Detroit, MI)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Supervisor** , you will help support clinicians ... position. **Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor...for additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position,… more
- Molina Healthcare (Provo, UT)
- … decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- R1 RCM (Boise, ID)
- …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help our ... position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct...at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position,… more
- MaineGeneral Health (Augusta, ME)
- Job Summary: MaineGeneral Health is seeking a qualified RN Clinical Appeals Specialist to support our Revenue Cycle team by reviewing denied insurance claims ... with MaineGeneral's mission of exceptional patient care Job Description: Position: RN Clinical Appeals Specialist Location: Alfond Center for Health,… more
- Aerotek (Tampa, FL)
- …including an explanation of the final decision and all External appeal rights. Licenses/Certifications RN - Registered Nurse - State Licensure And/or Compact ... **Description** PURPOSE: The Clinical Appeals Specialist completes research basic...Certified Case Manager Upon Hire Pref LNCC - Legal Nurse Consultant Certified Upon Hire Pref **Pay and Benefits**… more
- R1 RCM (Boise, ID)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** +...external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + An active CCS,… more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... programs lines of business. Ensures quality management of the clinical appeal process to reduce the risk of State...for Care Management. We are looking for an experienced RN leader in the greater Baltimore metropolitan area who… more
- Healthfirst (NY)
- …and grievances determinations + Additional duties as assigned **Minimum Qualifications:** + LPN or RN license + 1+ years of Appeals and Grievances experience + ... Responsibilities:** + Conduct quality audits of A&G items cases grievances, pre-service appeals , and post service appeals utilizing appropriate sources of… more
- Commonwealth Care Alliance (Boston, MA)
- …and sound clinical judgment in reviewing medical records and writing appeals . + Participate in telephonic Administrative Law Judge Hearings and present oral ... 011540 CCA- Appeals & Grievances **Position Summary:** Investigate and resolve...audits in preparation of regulatory site visits. + Provide clinical care to members via telehealth technologies (video, chat,… more
- Guardian Life (Bethlehem, PA)
- The **Senior RN Clinical Consultant** will work in partnership with Clinical and Vocational Leaders to provide ongoing coaching and oversight to Clinical ... subject matter expert in all lines of business (STD/LTD/ Appeals ) and products, action planning management, and Guardian systems....and Guardian systems. This incumbent will have a strong clinical and client focus to assist in ensuring the… more
- Independent Health (Buffalo, NY)
- …regulatory standards, clinical criteria, and member benefit contract. **Qualifications** + Registered Nurse ( RN ) with active, current, unrestricted NYS ... Trustworthy, Collaborative and Accountable. **Essential Accountabilities** + Thoroughly investigate clinical appeals and complaints/grievances utilizing appropriate internal… more
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... Coder (CIC), Registered Health Information Management Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Clinical Documentation… more
- ManpowerGroup (Columbia, SC)
- …industry, is seeking an Analyst, Appeals to join their team. As an Analyst, Appeals , you will be part of the clinical review department supporting the ... regulations or standards. + Perform thorough research of service appeals based on clinical documentation, contractual requirements,...quality assurance, or home health. + An active, unrestricted RN license from the United States and in the… more
- Children's Mercy Kansas City (Kansas City, MO)
- …or demonstrated leadership skills in a previous role + One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon ... administrative processes and data related to medical necessity denials, clinical appeals , long length of stay rounds,...hire + One of the following: Licensed RN - Kansas, Registered Nurse … more
- Centene Corporation (Tacoma, WA)
- …Administration required. Experience in Behavioral Healthcare field required. Registered Nurse ( RN ), Licensed Clinical Social Worker (LCSW), Licensed ... or Healthcare Administration required **Experience in Behavioral Healthcare field preferred:** Registered Nurse ( RN ) certification, Licensed Mental Health… more
- State of Colorado (Denver, CO)
- …(HP III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4966056) Apply Registered Nurse Health Compliance Inspector Home Care - ... Registered Nurse Health Compliance Inspector Home Care -...FAA00601 (HP III RN ) Salary $72,336.00 Annually Location Denver, CO Job Type Full Time… more
- Corewell Health (Royal Oak, MI)
- …experience in care management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan License Upon ... criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization… more
- State of Colorado (Denver, CO)
- …III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4966096) Apply Registered Nurse Health Compliance Inspector, Nursing ... Registered Nurse Health Compliance Inspector, Nursing...Facilities - FAA00392 (HP III RN ) Salary $72,336.00 Annually Location Denver, CO Job Type… more
- Centene Corporation (Baton Rouge, LA)
- …or Healthcare Administration required **Experience in Behavioral Healthcare field preferred:** Registered Nurse ( RN ) certification, Licensed Mental Health ... with customer expectations and lead clinical quality initiatives. Review clinical information for appeals to determine medical necessity of services,… more
- Elevance Health (Seattle, WA)
- **Manager II Grievance/ Appeals ( RN )** **Location** : **Hybrid 2:** This role requires associates to be in-office **3** days per week, fostering collaboration and ... contracts, benefits, clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non- clinical and clinical services,… more
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