- Humana (Hartford, CT)
- **Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals . The Appeals Nurse ... and independent determination of the appropriate courses of action. The Appeals Nurse 2 reviews documentation and interprets data obtained from clinical records… more
- Evolent (Hartford, CT)
- …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
- CVS Health (Hartford, CT)
- …day. **Position Summary** Responsible for the review and resolution of clinical appeals . Reviews documentation and interprets data obtained from clinical records to ... as required. This position may support UM, MPO, Coding, or Behavioral Health appeals . **Required Qualifications** * Must have active and unrestricted RN licensure in… more
- Cognizant (Hartford, CT)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Nuvance Health (Danbury, CT)
- …REQUIRED* * *Hybrid/Remote* * *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within ... notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the...* Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum of… more
- Nuvance Health (Danbury, CT)
- …operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical support staff while partnering with local case management ... organizational efficiency, and maximized reimbursement through denial reduction and successful appeals . The *System Care Coordination Leader* will be responsible for… more
- Sharecare (Hartford, CT)
- …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
- Eastern Connecticut Health Network (Manchester, CT)
- …in an applicable field required + Must have a current license as a Registered Nurse in the State of Connecticut . + Professional certification in case management or ... one week of discharge or receipt of a notice of denial. Successfully appeals denials, when indicated. + Performs comprehensive assessments and re-assessments of the… more