- TEKsystems (San Bernardino, CA)
- Description We are seeking a dedicated Clinical Appeals Nurse to join our Revenue Cycle Management team. The ideal candidate will be responsible for managing ... documentation to support appeals , and following up on submitted appeals . The Clinical Appeals Specialist will work closely with a team of Licensed… more
- Molina Healthcare (Tacoma, WA)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within ... compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical reviews of previously denied cases in which… more
- Centene Corporation (New York, NY)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals...Licensed Practical Nurse - State Licensure required or + LVN - Licensed Vocational Nurse required or + RN… more
- Evolent (Cheyenne, WY)
- …adjudication of processed appeals . **What You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review as an LPN or ... 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… more
- Sharp HealthCare (San Diego, CA)
- …**Shift Start Time** **Shift End Time** Other; California Licensed Vocational Nurse ( LVN ) - CA Board of Vocational Nursing & Psychiatric Technicians **Hours** **:** ... **Required Qualifications** + Other : Graduate of an accredited Licensed Vocational Nurse ( LVN ) program. + California Licensed Vocational Nurse ( LVN ) - CA Board… more
- Molina Healthcare (Long Beach, CA)
- …Delegation Oversight Manager with additional duties of the team. We are looking for LVN 's with at least 4 years of UM experience, NCQA accreditation, and knowledge ... in this role. Productivity is important with quick turnaround times. Experience with Appeals , Auditing, and Compliance /Quality will be a good fit for this position.… more
- Bakersfield Behavioral Healthcare Hospital (Bakersfield, CA)
- …of the Utilization Review Specialist is to review medical records and prepare clinical appeals (when appropriate) on medical necessity, level of care, length ... requirements for the position such as a High School Diploma and a current California LVN License we're really looking for people who bring their HEART to work. If… more
- UCLA Health (Los Angeles, CA)
- …play a key part in promoting high-quality, cost-effective medical care by applying clinical acumen and applicable policies and guidelines in the issuance of adverse ... processing of all written notifications. You will also provide clinical guidance on denial cases and ensure that all...an exceptionally gifted, self-motivated leader with: + Current CA LVN licensure required + Two or more years of… more
- ManpowerGroup (Columbia, SC)
- …an Accredited School of Licensed Practical Nursing (LPN) or Licensed Vocational Nursing ( LVN ). **Experience:** + Minimum **2 years of clinical experience** in a ... eligibility and medical necessity of services. + Handle first-level appeals , ensuring detailed documentation of determinations. ✔ **Education & Communication… more