- CareFirst (Owings Mills, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes ... regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all applicable State and Federal… more
- Penn State Health (Hershey, PA)
- …Garrett C. Kieffer at ###@pennstatehealth.psu.edu 100% Remote Position **SUMMARY OF POSITION:** The clinical appeals nurse will be responsible for reviewing ... Instructions for Job Applicants PDF for more detailed steps for assistance._ **Position** Clinical Appeals Nurse ( Clinical Documentation / Clinical … more
- HCA Healthcare (Brentwood, TN)
- **Description** **Introduction** Do you have the career opportunities as a Clinical Appeals Nurse RN you want with your current employer? We have an exciting ... a committed, caring group of colleagues. Do you want to work as a Clinical Appeals Nurse RN where your passion for creating positive patient interactions are… more
- R1 RCM (Boise, ID)
- …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
- UNC Health Care (Chapel Hill, NC)
- …the unique communities we serve. RN Utilization Manager position specifically for a Utilization Manager/ Clinical Appeals Nurse . This person is based at the ... Hedrick building and is 100% on-site. This individual combines clinical , business, and regulatory knowledge to reduce significant financial risk caused by concurrent… more
- Kepro (Indianapolis, IN)
- …solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Job Summary: Our ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...Utilization Management Appeals Nurse - LPN/RN will help orchestrate… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II… more
- Elevance Health (Los Angeles, CA)
- ** Nurse Appeals - Licensed Nurse **.../grievances/quality of care issues and is a resource for clinical and non clinical team members in expediting ... locations. **Shift:** Monday to Friday from 8:00-5:00 pm PT The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- CVS Health (Hartford, CT)
- …position are Monday-Friday 8a-5p in time zone of residence. Position Summary The Appeals Nurse Consultant position is responsible for processing the medical ... a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,...in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates… more
- CVS Health (Hartford, CT)
- …or 9-6 in designated time zone) with occasional weekends and holidays. The Appeals Nurse Consultant position is responsible for processing the medical necessity ... a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,...in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates… more
- Elevance Health (Costa Mesa, CA)
- ** Nurse Appeals - California candidates only** **Location: This is a virtual position and prefer candidates reside within 50 miles of an Elevance Health ... impact:** Responsible for investigating and processing and medical necessity appeals requests from members and providers. **Primary duties may.../grievances/quality of care issues and is a resource for clinical and non clinical team members in… more
- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you want to join an organization that invests in you as a Clinical Appeals Team Lead? At Parallon, you come first. HCA Healthcare has ... make a difference. We are looking for a dedicated Clinical Appeals Team Lead like you to...substitute experience requirement. + Currently licensed as a registered nurse (RN) or (LPN) in the state(s) of practice… more
- CVS Health (Hartford, CT)
- …residence with occasional rotational weekend and holiday coverage. Position Summary The Appeals Nurse Consultant position is responsible for processing the ... a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,...in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical quality oversite. This ... UM team/ Appeals within managed care setting. + 3+ years' experience in clinical nurse setting preferred. + Grievance experience preferred. + TPA experience… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... the safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing… 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 ... **Must have a New York State clinical license.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical… more
- Trinity Health (Farmington Hills, MI)
- …and determining root causes of clinical denials. Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, ... of stay, level of care, missing pre-certification, or other clinical reasons and constructing warranted appeals for...possess a demonstrated knowledge of denial management functions. Registered Nurse and a graduate of an accredited school of… more
- CVS Health (Hartford, CT)
- …business hours 8a-5p in time zone of residence Monday - Friday. The Appeals Nurse Consultant position is responsible for processing the medical necessity ... of Medicare appeals for participating providers. Primary duties may include, but...duties may include, but are not limited to: Requesting clinical , research, extrapolating pertinent clinical , applying appropriate… more
- Penn Medicine (Philadelphia, PA)
- …your life's work? **Summary:** Responsible for coordinating office activities for the Clinical Appeals Coordinators to assist the department in accomplishing the ... the appeal process if appropriate. + Interacts with on-site nurse reviewers to provide required ID badges, Statement of...continuity of communication. + Supports the activities of the Clinical Appeals Coordinator in all phases of… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES...health plan. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California, Active BLS -… more