- Evolent (Washington, DC)
- …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 (Washington, DC)
- …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
- CareFirst (Baltimore, MD)
- …with dynamic goals resulting in the full and fair review of appeals and grievances designed to achieve corporate objectives and advance departmental capabilities. ... and accreditation requirements. Ensures appropriate and complete resolution of appeals , Regulatory complaints and External review requests. Performs analytics and… more
- Johns Hopkins University (Baltimore, MD)
- …transplant hepatology to acquire further expertise in these clinical areas. The Nurse Practitioner Fellowship Program also provides a means to help transition the ... nurse practitioner into a career in the specialty of...ongoing care. + Assist with medication prior authorizations and appeals . + Assist MOC with procedure pre-authorizations as needed.… more
- Johns Hopkins University (Washington, DC)
- The Department of Medicine is seeking a licensed ** Nurse Practitioner Fellow** for an intensive 12-month training program designed to provide advanced didactic ... DC, Bethesda, MD, and may occasionally require travel to Columbia, MD. The Nurse Practitioner Fellowship Program also provides a means to help transition the … more
- Ascension Health (Baltimore, MD)
- …related to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals . + Assess and coordinate discharge planning needs with ... and regulations. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Maryland Board of Nursing obtained prior to… more
- Sharecare (Washington, DC)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more