- …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help our ... remote, production-driven position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical… more
- Molina Healthcare (Salt Lake City, UT)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions… more
- R1 RCM (Salt Lake City, UT)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help ... remote production-drive position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to… more
- Evolent (Salt Lake City, UT)
- …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 ... and client policies and procedures while complying with timeliness guidelines. Our clinical nurse reviewer team values collaboration, continuous learning, and a… more
- Evolent (Salt Lake City, UT)
- …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...be able to exercise independent and sound judgment in clinical decision making. - **Preferred** + Able to navigate… more
- R1 RCM (Salt Lake City, UT)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Supervisor** , you will help support clinicians ... position. **Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor...additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay… more
- University of Utah Health (Salt Lake City, UT)
- …continued stay review. + Communication to third-party payers for initial and concurrent clinical review. + Reviews patient chart to ensure patient continues to meet ... LOS, expected cost, or over/under-utilization of resources. + Performs verbal/fax clinical review with payer as determined by nursing judgment and/or collaboration… more
- Molina Healthcare (Salt Lake City, UT)
- …state, and local laws and regulatory requirements affecting the medical and clinical staff. **Job Duties** + Provides medical oversight and expertise in ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more