- Elevance Health (Olathe, KS)
- ** Nurse Appeals ** **Location:** This position will work a hybrid model (remote and office). Candidates must reside in Olathe, KS, Topeka, KS, or Overland Park, ... KS. The ** Nurse Appeals ** role is responsible for investigating and processing and medical necessity appeals requests from members and providers. **How you… more
- R1 RCM (Salt Lake City, UT)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Nurse ** , you will help our hospital clients by ... production-driven position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical records and… more
- R1 RCM (Chicago, IL)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid… 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...experience + Utilization Management experience + Coding experience + Appeals experience **Education** + Associate's Degree minimum OR Diploma… more
- Genesis Healthcare (Philadelphia, PA)
- …guidance for appeal requests at all levels.Maintains tracking records of appeals management activities in accordance with department policiesPerforms other duties as ... requested.Qualifications: Registered Nurse .Significant experience in the Healthcare Industry.Knowledge of regulatory requirements for reimbursement and reasons for… more
- St. Mary's Healthcare (Amsterdam, NY)
- …and audit requests and coordinates attempts to overturn denials by drafting appeals , negotiating with payers, or following up with payer utilization review ... nursing required. Licensure / Certification / Registration: Required Credential(s): * Registered Nurse credentialed from the New York Board of Nursing. Complexity of… more
- Trinity Health (Springfield, MA)
- …Shift **Description:** Requires BSN At **Mercy Medical Center** the **Utilization Review/ Appeals & Denials** **RN** performs utilization review with payers, assists ... determinations using screening criteria, and assists the physician, bedside Registered Nurse , ICC and Social Worker with utilization management and clinical… 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 ... and audits subcontractors who have delegated responsibility for managing grievance and appeals on behalf of the plan to ensure operational and regulatory compliance.… 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 ... appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and reporting… more
- R1 RCM (Boise, ID)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Supervisor** , you will help support clinicians who conduct a ... comprehensive review of clinical denials and formulate appeals based on clinical documentation, evidence-based medical necessity criteria, physician documentation,… 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, 90017 ... safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the… 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 ... The Fields + Weekend Requirements: no + Other Posting Information: Registered Professional Nurse (RN) License Illinois upon hire. + Holiday Requirements: no Email a… more
- McLaren Health Care (Bay City, MI)
- …. Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews ... of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and achieve optimal payment for… more
- BronxCare Health System (Bronx, NY)
- …the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to ... identification of patterns and trends identified during the course of appeals preparation. Conduct departmental performance improvement audits, analyze findings and… more
- CDPHP (Albany, NY)
- …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 ... Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations about… more
- HCA Healthcare (Nashville, TN)
- …Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Clinical Appeals Team Lead with Parallon you can be a part of an organization ... our organization. We are looking for an enthusiastic Clinical Appeals Team Lead to help us reach our goals....Unlock your potential! **Job Summary and Qualifications** The Compliance Nurse Team Lead is responsible for providing clinical input… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and grievance ... of cases; review, research and coordination of complaints, grievances, appeals and reconsiderations consistent with statutory and federal regulatory guidelines.… more
- Baptist Memorial (Memphis, TN)
- Summary Medicare / Medicaid Appeals Registered Nurse reviews and evaluates medical documentation to support billing compliance and external regulatory ... Responsibilities + Abstracts pertinent information from the medical record to create appeals for cases denied by governmental payors. + Educates department staff to… more
- The Cigna Group (Bloomfield, CT)
- **Cigna Medicare Part C Appeals Reviewer: Appeals Processing Analyst** We will depend on you to communicate some of our most critical information to the correct ... individuals regarding Medicare appeals and related issues, implications and decisions. The Case...Additional duties as assigned. **Qualifications** + Education: Licensed Practical Nurse (LPN) or Registered Nurse (RN) +… more
- State of Colorado (CO)
- CDOC Nurse Supervisor Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4383689) Apply CDOC Nurse Supervisor Salary $8,204.00 - $11,487.00 ... Statewide, CO Job Type Full Time Job Number CAA Nurse III 2/2024 Department Department of Corrections Division Clinical...of the department's action. For more information about the appeals process, the official appeal form, and how to… more