- Molina Healthcare (Columbus, OH)
- …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 (Columbus, OH)
- …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 (Columbus, OH)
- …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
- Molina Healthcare (Columbus, OH)
- …responsibilities will include specialized medical necessity reviews and/or appeals and supporting market performance. Performance activities include physician ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
- Elevance Health (Columbus, OH)
- …will make an impact:** + Perform physician-level case review, following initial nurse review, of Medical Oncology regimens and supportive care. + Perform ... physician-level case review, following initial nurse review, of chemotherapy regimens. + Determine medical necessity...a subject matter expert. + Perform first level provider appeals as designated by the client for adverse determinations.… more
- Trinity Health (Columbus, OH)
- …RHIA, RHIT, CCS, CPC/COC or other coding credentials and/or Licensed Vocational Nurse / Licensed Practical Nurse licensure is required. CHC (Healthcare Compliance ... accordingly. Epic experience desired. 9. Experience and knowledge of working on appeals for insurance denials and identifying root cause. 10. Knowledge of Hospital… more
- Elevance Health (Columbus, OH)
- …Director is responsible for collaborating with health plan partners, company nurse practitioners, and an interdisciplinary team to ensure delivery of high-quality ... a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any… more
- Elevance Health (Columbus, OH)
- …including assessments, service planning, care coordination, transition planning, member appeals , state hearings, and member and caregiver education and training. ... an equivalent background. Preferred Skills, Capabilities and Experiences: + Licensed Registered Nurse (RN) or Licensed Independent Social Worker (LISW) for the state… more