- Elevance Health (Los Angeles, CA)
- ** Nurse Appeals - Licensed RN Nurse ** **Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live in the state of ... our PulsePoint locations. **Shift:** Monday to Friday from 8:00am-5:00pm PST The ** Nurse Appeals ** is responsible for investigating and processing medical… 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, CA, ... 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
- CVS Health (Hartford, CT)
- …**Position Summary** Responsible for the review and resolution of clinical appeals . Reviews documentation and interprets data obtained from clinical records to ... as required. This position may support UM, MPO, Coding, or Behavioral Health appeals . **Required Qualifications** + Must have active and unrestricted RN licensure in… more
- VNS Health (Manhattan, NY)
- OverviewManages the day to day activities for staff handling of grievances and appeals for one of the following VNS Health Plans product lines - Managed Long Term ... subcontractors who have delegated responsibility for managing grievance and appeals on behalf of the plan to ensure operational...paid time off and 9 company holidays + Health insurance plan for you and your loved ones, Medical,… more
- Dayton Children's Hospital (Dayton, OH)
- …pre certify accounts, and appeal observation, inpatient, medical necessity, and DRG insurance denials. This role functions as an internal liaison for members of ... Demonstrates dynamic ability to adapt to ongoing changes within the health insurance industry to effect and implement positive changes for the financial growth… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage ... decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and...paid time off and 9 company holidays + Health insurance plan for you and your loved ones, Medical,… more
- Centene Corporation (New York, NY)
- …license.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more
- Carle (Urbana, IL)
- Outpatient Denial/ Appeals Specialist- RN + Department: Revenue Cycle - CFH_10_19 + Entity: Champaign-Urbana Service Area + Job Category: Clerical/Admin + Employment ... from Home + Weekend Requirements: no + Other Posting Information: Registered Professional Nurse (RN) License Illinois upon hire. + Holiday Requirements: no Email a… more
- CDPHP (Albany, NY)
- …and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York. The company values people, ... values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and grievance process… more
- Adecco US, Inc. (Los Angeles, CA)
- Adecco Healthcare & Life Sciences is hiring an Appeals Pharmacist. This role is remote / work from home. Please read below and apply with an updated resume for ... to 5pm PST **Pay:** $70.00 to $73.00 an hour **Responsibilities of the Appeals Pharmacist:** . Collaborates with the coordinators and nurses to process referrals,… more
- Travelers Insurance Company (Tampa, FL)
- …Imagine loving what you do and where you do it. **Job Category** Claim, Nurse - Medical Case Manager **Compensation Overview** The annual base salary range provided ... regarding payment decisions for surgical services. Providing Medical Provider Appeals Analysts with expert technical support for most complex...a plus. **What is a Must Have?** + Registered Nurse or Licensed Practical Nurse with Surgical… more
- State of Colorado (Denver, CO)
- Registered Nurse I-$25,000 SIGN ON BONUS Colorado Mental Health Hospital in Fort Logan-Denver Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4716699) Apply Registered Nurse I-$25,000 SIGN ON BONUS Colorado Mental Health Hospital in Fort… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4555045) Apply CDOC Registered Nurse ( Nurse I) ... Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 7/2024 Department Department of Corrections Division...+ Medical and Dental Health Plans; + Paid life insurance ; + Short and long-term disability coverage; + 11… more
- State of Colorado (Denver, CO)
- Charge Nurse RN II - Mental Health Hospital in Fort Logan (S. Denver) *$25,000 Sign On Bonus* Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4716347) Apply Charge Nurse RN II - Mental Health Hospital in Fort...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)
- NURSE CONSULTANT Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4715738) Apply NURSE CONSULTANT Salary $98,448.00 - $137,844.00 Annually ... the work assignment. Current, valid licensure as a Registered Nurse from the Colorado Board of Nursing or any...of the department's action. For more information about the appeals process, the official appeal form, and how to… more