- Molina Healthcare (Lexington, KY)
- …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...denied cases in which a formal appeals request has been made or upon request by… more
- Evolent (Frankfort, KY)
- …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 of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to… more
- Evolent (Frankfort, KY)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- BrightSpring Health Services (Louisville, KY)
- …documentation and minimize lost revenue. They conduct analysis on denials and appeals and identify trends that present process improvement and revenue protection ... will also support detailed level reporting and analytics, clinical appeals , root cause analysis, and address identified trends in...+ Current license/registration by state of hire as a nurse + Two years of experience in health care… more
- Molina Healthcare (Lexington, KY)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends… more
- BrightSpring Health Services (Louisville, KY)
- …issues. Refer all unresolved issues to the next level including grievance and appeals . + Actively market plan to new senior care partners within plan Service ... needs and provide preventive, coordinated, and quality healthcare. With a dedicated nurse practitioner leading a personalized care plan, we strive to improve the… more