- R1 RCM (Chicago, IL)
- …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 (KY)
- …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 (Detroit, MI)
- …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
- Commonwealth Care Alliance (Boston, MA)
- …and sound clinical judgment in reviewing medical records and writing appeals . + Participate in telephonic Administrative Law Judge Hearings and present oral ... 011540 CCA- Appeals & Grievances **Position Summary:** Investigate and resolve...audits in preparation of regulatory site visits. + Provide clinical care to members via telehealth technologies (video, chat,… more
- Evolent (Juneau, AK)
- …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 (San Juan, PR)
- …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
- Elevance Health (Mason, OH)
- ** Nurse Appeals - Medicare** **Location:** Virtual:.../grievances/quality of care issues and is a resource for clinical and non clinical team members in ... shifts from Tuesday to Saturday and coverage on certain holidays. The ** Nurse Appeals - Medicare** is responsible for investigating and processing and medical… more
- R1 RCM (Detroit, MI)
- …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
- CareFirst (Baltimore, MD)
- …members for government programs lines of business. Ensures quality management of the clinical appeal process to reduce the risk of State and Federal Regulatory fines ... with dynamic goals resulting in the full and fair review of appeals and grievances designed to achieve corporate objectives and advance departmental capabilities.… more
- Centene Corporation (Austin, TX)
- …all appeals requests. + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by… more
- Ochsner Health (New Orleans, LA)
- …at Ochsner Health and discover your future today!** This job applies clinical expertise as well as knowledge of utilization and discharge planning criteria ... it relates to all medical necessity audits. **Education** Required - Registered Nurse Diploma Preferred - Associate's or Bachelor's degree in Nursing **Work… more
- LA Care Health Plan (Los Angeles, CA)
- …needed by nurse and in compliance with PP/PPG contracts. Completes non- clinical aspects of Clinical Grievance Resolution Letter using appropriate template ... Customer Solution Center Appeals and Grievances Specialist III Job Category: Customer...needed to investigate, coordinate care and support resolutions for clinical and non- clinical cases. Identifies, investigates, and… more
- Baylor Scott & White Health (Temple, TX)
- …expedited and external case reviews, and prepares final case submissions. + Refers clinical appeal cases to Medical Nurse Auditors or Pharmacy Technicians for ... level **Job Summary** **Hybrid position - limited time working onsite** The Appeals and Grievance Specialist reviews member and provider complaints, appeals ,… more
- WMCHealth (Valhalla, NY)
- Asst Utilization Coordinator - Appeals Company: Westchester Medical Center City/State: Valhalla, NY Category: Nursing/Nursing Management Department: Clinical ... by the New York State Department of Education, as a registered professional nurse . Training and Experience: three years of experience where the primary function of… more
- Veterans Affairs, Veterans Health Administration (Buffalo, NY)
- Summary The Western New York VA Medical Center is hiring one, full-time Registered Nurse - Clinical Assessor to work as part of the Caregiver Support Program at ... the Buffalo, NY location. The Caregiver Support Program Registered Nurse - Clinical Assessor executes position responsibilities that demonstrate leadership,… more
- City and County of San Francisco (San Francisco, CA)
- …Nurse (RN) license issued by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a valid Clinical ... centers. Under general medical and nursing direction, you will perform pediatric clinical nursing duties in hospitals, clinics, and community health centers. As a… more
- City and County of San Francisco (San Francisco, CA)
- …EXPERIENCE: At least one (1) year of experience working as a Registered Nurse SPECIALTY REQUIREMENTS: + Clinical Documentation Specialist (CCDS) certification + ... Reviews inpatient medical records for identified payor populations. + Ensures that clinical documentation reflects the appropriate level of service. + Utilizes both … more
- Independent Health (Buffalo, NY)
- …Collaborative and Accountable. **Essential Accountabilities** + Thoroughly investigate clinical appeals and complaints/grievances utilizing appropriate internal ... support of a high performing health plan and physician network. The Clinical Reviewer will investigate quality complaints/grievances and appeals , document… more
- State of Colorado (Denver, CO)
- Charge Nurse RN II - CO Mental Health Hospital in Fort Logan (S. Denver) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4964353) Apply Charge ... Nurse RN II - CO Mental Health Hospital in...coordinates and implements medical and psychiatric crisis intervention in clinical emergencies assuring compliance with nursing standards and policies/procedures.… more
- State of Colorado (Denver, CO)
- …assigning responsibilities + During specific shifts, functions in the role of Charge Nurse and provides clinical and administrative supervision of nursing staff ... of work, providing clinical leadership and teaching clinical interventions + Functions as the Charge Nurse...of the department's action. For more information about the appeals process, the official appeal form, and how to… more