- US Tech Solutions, Inc. (Columbia, SC)
- …and appeals . Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. ... Job Title: Licensed Practical Nurse Location: Columbia SC 29229 Duration: 3+ Months...Participates in all required training. Experience: . 2 years clinical experience. Required Licenses and Certificates: Active, unrestricted LPN/LVN… more
- Compass Health Network (Raymore, MO)
- …interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion" ... our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our...ensure our clients are taken care of. An Outpatient Nurse will have a Monday through Friday schedule with… more
- Compass Health Network (Raymore, MO)
- …interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion" ... our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our...ensure our clients are taken care of. An Outpatient Nurse will have a Monday through Friday schedule with… more
- Compass Health Network (Sullivan, MO)
- …interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion" ... to best serve our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our clients are taken care… more
- Compass Health Network (Sullivan, MO)
- …interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion" ... to best serve our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our clients are taken care… more
- RestoraCare Staffing (Houston, TX)
- RestoraCare Staffing is seeking a Registered Nurse (RN) Case Management for a nursing job in Houston, Texas.Job Description & RequirementsSpecialty: Case ... Social Work program. Licenses/Certifications: Current and valid license to practice as a Registered Nurse in the state of Texas or Current and valid license as a… more
- APN Consulting, Inc (TX)
- …with coworkers, clients, members, providers and customers.Daily Responsibilities:Completing non- clinical appeals reviews for overpaid claims.Complete repricing ... works under the supervision of the Medical Claims Review Nurse and is cross-trained to work in a variety...work in a variety of areas and functions, including appeals , claims analytics, DRG Validation claims repricing, and outpatient… more
- Accounting Now (Tampa, FL)
- The Denials Specialist performs advanced-level work related to clinical and coding denial management and appeals follow-up. The individual is responsible for ... and appeal processes and escalates timely filing requests to Leadership.Collaborates with Clinical Denials Nurse , Coding Denials Specialists, and Leadership in… more
- VNS Health (New York, NY)
- …requests for services from providers, members, and care management team and renders clinical determinations in accordance with VNS Health Plans policies as well as ... state and federal regulations. Delivers timely notification detailing VNS Health clinical decisions. Coordinates with VNS Health Plans team, subject matter experts,… more
- Christus Health (Alamogordo, NM)
- …on Apply to be considered for this position.Five years recent relevant clinical experience in an acute care facility required.Strong Interpersonal skills and ability ... Medicare Conditions of Participation, DNV standards, HIPAA, and reporting requirements.Submits appeals in a timely manner, upon request by the Director.Initiates… more
- HCA Healthcare (Nashville, TN)
- …**Introduction** Do you want to join an organization that invests in you as a Clinical Appeals Nurse Manager? At Parallon, you come first. HCA Healthcare ... and you have the opportunity to make a difference. We are looking for a dedicated Clinical Appeals Nurse Manager like you to be a part of our team. **Job… more
- Actalent (Dayton, OH)
- We are hiring for a Clinical Appeals Nurse (RN). This is a fully remote role for someone who is licensed in Ohio! Description: Job Summary: The Clinical ... Appeals Nurse is responsible for the completion of clinical appeals and state hearings from all states. Essential Functions: * Responsible for the… 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 (Salt Lake City, UT)
- …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
- 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
- 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
- CVS Health (Hartford, CT)
- …Basic awareness of problem solving and decision making skills 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
- 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
