- Molina Healthcare (TX)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... **_For this position we are seeking a REGISTERED NURSE (RN) with prior experience in Utilization Review...discussed during our interview process._** **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate… 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
- R1 RCM (Salt Lake City, UT)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help ... basic computer skills is essential for excelling in this remote production-drive position. **Here's what you will experience working...position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** +… more
- CVS Health (Hartford, CT)
- …telework position. Hours for this role are Monday-Friday 8a-5p. 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
- 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, ... patient status, length of stay, level of care, missing pre-certification, or other clinical reasons and constructing warranted appeals for defined populations as… more
- Elevance Health (Hendersonville, 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.../grievances/quality of care issues and is a resource for clinical and non clinical team members in… more
- Elevance Health (Rancho Cordova, CA)
- ** Nurse Appeals - Licensed RN Nurse...** **Location:** This position will work a hybrid model ( remote and office). Ideal candidates will live in the state ... **Shift:** Monday to Friday from 8:00-5:00 pm PT The ** Nurse Appeals ** is responsible for investigating and.../grievances/quality of care issues and is a resource for clinical and non clinical team members in… more
- Motion Recruitment Partners (Durham, NC)
- Clinical Appeals Analyst Durham, NC **100% Remote ** Contract $35/hr - $39/hr Our client, a nationally recognized and award-winning company in the health ... has a possible contract to hire opening for a Clinical Appeals Analyst. They have over 4...outcomes while reducing costs. ** While the position is Remote , work from home, you must reside in North… more
- Centene Corporation (Columbus, OH)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... including a fresh perspective on workplace flexibility. Position is REMOTE but must reside in Ohio **Position Purpose:** Performs... but must reside in Ohio **Position Purpose:** Performs clinical reviews needed to resolve and process appeals… more
- Trinity Health (Farmington Hills, MI)
- …manner possible: + Coordinates follow-up activities with Utilization Review/Case Management/Coding/ Nurse Liaison to provide required clinical support, as ... Type:** Full time **Shift:** Day Shift **Description:** **POSITION PURPOSE** Work Remote Position (Pay Range: $18. 4663-$27.6994) Performs day-to- day payment… more
- Penn Medicine (Bala Cynwyd, PA)
- …UPHS areas. + Direct supervision of hospital Compliance Analysts, Senior Compliance Analyst, Nurse Auditor, and Analyst Government Audits and Appeals + Recruit ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more
- State of Colorado (Pueblo, CO)
- Registered Nurse III - Clinical Trainer - Pueblo Regional Center $7,000 Sign-on Incentive Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4524154) Apply Registered Nurse III - Clinical Trainer - Pueblo Regional Center $7,000 Sign-on… more
- Providence (OR)
- **Description** Providence Health Plan is calling a Clinical Program Coordinator RN who will provide care coordination, case management and care management services ... best people, we must empower them._** **Providence Health Plan is calling a Clinical Program Coordinator RN who will:** + Provide care coordination, case management… more
- Actalent (Sacramento, CA)
- … and Grievances Manager. + In this role, you will perform accurate and timely clinical review of Member-initiated appeals . + The RNs perform first level appeal ... Description: + The Medi-Cal Member Appeals and Grievances team is responsible for clinically...compliance. + In this role, you will also perform clinical oversight of all Medi-Cal grievances. + In this… 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
- State of Colorado (Denver, CO)
- Charge Nurse RN II - CO Mental Health Hospital in Fort Logan (S. Denver) *$14,000 Sign On Bonus* Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/3991151) Apply Charge Nurse RN II - CO Mental Health Hospital in Fort Logan (S. Denver) *$14,000… more
- State of Colorado (Rifle, CO)
- Nurse I - $7,000 Sign-on Incentive - Full Time & Part-Time - Rifle VCLC - Rifle, CO Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4459521) ... Apply Nurse I - $7,000 Sign-on Incentive - Full Time...Assessment: + Performs both admission and daily assessments during clinical stay, identifying critical stay, identifying critical incidents, emergencies,… more
- State of Colorado (Denver, CO)
- Registered Nurse I - Gilliam Youth Services Center - $7,000 Sign on Incentive! Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4518236) Apply ... Registered Nurse I - Gilliam Youth Services Center - $7,000...shift offered. We have multiple openings. Specific Job Duties: Clinical Duties: Ensures the provision of patient care is… more
- International Medical Group (Indianapolis, IN)
- …an active RN license in good standing in Indiana. + Location: Hybrid or Remote working options. + Corporate office is in Indianapolis, IN. + Relocation Expenses ... outpatient management of assistance cases. + Knowledge of the Non-certification process and Appeals process including logs and time frames. + Participate in the on… more
- Sharecare, Inc. (Columbus, OH)
- …available 3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and ... Summary:** The role of the Family Health Advocate is an exciting and innovative remote role newly created to provide meaningful support to members and their families… more