- Evolent (Nashville, TN)
- …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 (Nashville, TN)
- …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
- Vanderbilt University Medical Center (Nashville, TN)
- …pre-certifications (which can take up to 1 hour for completion) and appeals . Other duties included scheduling imaging, requesting outside records, mailing documents ... of emphasizing negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC-Registered Nurse - Licensure-Others **Work Experience:** Relevant Work Experience **Experience… more
- Sharecare (Nashville, TN)
- …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
- CVS Health (Franklin, TN)
- …accordance with contract. + Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) ... incoming correspondence and internal referrals. + Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. + Performs… more
- Community Health Systems (Franklin, TN)
- …role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate efficient ... and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required + CCM -… more