- Christus Health (Houston, TX)
- …liaison and point of contact for clinical denials and appeal inquiries. The Clinical Appeals Nurse will review each case identified/referred for appeal based on ... viability of the appeal, and manage the appeal process. The Clinical Appeals Nurse is responsible for appealing all inappropriate denials through all possible… more
- VNS Health (Manhattan, NY)
- …navigating the complexities of healthcare? VNS Health Plans is seeking a dedicated Manager, Grievance and Appeals (RN)to lead the daily operations of our ... grievance and appeals processes. You will play a crucial role in...+ License and current registration to practice as a registered professional nurse in New York State… more
- VNS Health (Manhattan, NY)
- …criteria. + Enters data and assists with compiling reports and analysis on the grievance and appeals process. + Participates in special projects and performs ... + License and current registration to practice as a registered professional nurse in New York State...care, including a minimum of two years in a grievance and appeals or related area such… more
- The Cigna Group (Bloomfield, CT)
- …activities as needed. + Additional duties as assigned. Qualifications + Education: Licensed Practical Nurse (LPN) or Registered Nurse (RN) + 3-5 years' ... Cigna Medicare Part C Appeals Reviewer: Appeals Processing Analyst We...Director. + Determine whether additional pre service, appeal or grievance reviews are required and/or whether additional appeal rights… more
- CareFirst (Baltimore, 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...High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact… more
- CareFirst (Baltimore, MD)
- …required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon ... NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department. We are looking...Manager Upon Hire Preferred or + LNCC - Legal Nurse Consultant Certified Upon Hire Preferred **Experience:** 5 years'… more
- CareFirst (Baltimore, MD)
- …**Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon ... 3 years supervisory experience Utilization Management, and Government Program experience with Appeals and Grievance , Experience with MCG, InterQual, NCD and… more
- CDPHP (Albany, NY)
- …, grievances, NYS external review, and making recommendations for change. QUALIFICATIONS: + Registered Nurse , Physician Assistant or Nurse Practitioner, with ... to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider...is responsible for adhering to a member/provider appeal and grievance process that meets state, federal, accreditation and other… more
- CareFirst (Baltimore, MD)
- …appeals nurse and non-clinical supporting team members within the Appeals and Grievance Department for Government Programs. Creates, updates and maintains ... addition to the required work experience. **Licenses/Certifications:** + Health Services\RN - Registered Nurse - State Licensure and/or Compact State Licensure… more
- CareOregon (Medford, OR)
- …a federal contractor and must comply with all federal laws. Job Title Registered Nurse - Care Coordinator (Community) Exemption Status Exempt Department Clinical ... in order to achieve optimal health and wellness outcomes. Registered Nurse - Care Coordinator is part...For Service program benefits). + Report member complaints to Appeals and Grievance team for investigation and… more
- ERP International (Nellis AFB, NV)
- **Overview** ERP International is seeking ** Registered Nurse (RN) Utilization Managers** for full-time positions in support of theMike O'Callaghan Military ... collect clinical data from inpatient and outpatient sources; provide documentation for appeals or grievance resolution; apply critical thinking skills and… more
- VNS Health (Nassau, NY)
- …eligibility. + Coordinates with other departments, eg Care Management, Legal Affairs, Grievance and Appeals , Compliance, Membership Eligibility Unit, Quality as ... Licenses and Certifications: + Current license to practice as a Registered Professional Nurse in New York State required + Certified Case Manager preferred… more
