- Elevance Health (Knoxville, TN)
- ** Nurse Appeals - Licensed Nurse ** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live in the state of ... 50 miles of one of our PulsePoint locations. The ** Nurse Appeals ** is responsible for investigating and...investigations and reviews of member and provider medical necessity appeals . + Investigates member grievances with a clinical… more
- The Cigna Group (Nashville, TN)
- …duties as assigned. **Qualifications** + Education: Licensed Practical Nurse (LPN) or Registered Nurse ( RN ) + 3-5 years' experience in Medicare Advantage ... **Cigna Medicare Part C Appeals Reviewer: Appeals Processing Analyst** We...as well as research and provide a written detailed clinical summary for the Plan Medical Director. + Determine… more
- Baptist Memorial (Memphis, TN)
- Summary Medicare / Medicaid Appeals Registered Nurse reviews and evaluates medical documentation to support billing compliance and external regulatory ... Responsibilities + Abstracts pertinent information from the medical record to create appeals for cases denied by governmental payors. + Educates department staff to… more
- BlueCross BlueShield of Tennessee (Nashville, TN)
- …**Job Qualifications** _Education_ + Masters in Social Work \(LCSW, LMSW, or LAPSW\) OR Registered Nurse \( RN \) OR Licensed Practical Nurse \(LPN\) ... Responsibilities** + Provides an interface for BlueCare internal departments, \(UM, Appeals , Population Health, BlueCare plus, etc\) and external partners \(other… more