- Elevance Health (Overland Park, KS)
- ** Nurse Appeals Lead - Medicaid Appeals ** Location: This position will work a hybrid model (remote and in office). The ideal candidate will live within ... **Norfolk, VA** + **Atlanta, GA** + **Tampa, FL** The ** Nurse Appeals Lead ** is responsible...: + AS or BS in Nursing preferred. + Medicaid Appeals knowledge preferred. + For URAC… more
- HCA Healthcare (Nashville, TN)
- …HCA 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 ... our organization. We are looking for an enthusiastic Clinical Appeals Team Lead to help us reach...Unlock your potential! **Job Summary and Qualifications** The Compliance Nurse Team Lead is responsible for providing… more
- Elevance Health (Tampa, FL)
- RN Utilization Management Nurse Sr. ( Medicaid -InPatient) JR130851 **Location:** Must be within 50 miles / 1 hour commute of Tampa or Miami, FL offices. This is ... Nurse Medical Management Sr** serves as T **eam Lead ** for nursing staff who collaborate with healthcare providers...of care and accurate claims payment. May also manage appeals for services denied. Primary duties may include, but… more
- State of Colorado (Pueblo, CO)
- NURSE II *Intermediate Acuity* CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4674955) Apply NURSE II *Intermediate Acuity* CMHHIP ... with criminal involvement. This position provides nursing oversight, administrative oversight and lead worker over nursing personnel of three or more FTE's on a… more
- Elevance Health (Tampa, FL)
- Job Description ** Nurse Medical Management Sr.** **Preferred Location** : Florida. **This position will work 100% remote (with the exception of team meetings which ... miles of one of our Elevance Health PulsePoint locations. ** Nurse Medical Management Sr.** Responsible to serves as team... Medical Management Sr.** Responsible to serves as team lead for nursing staff who collaborate with healthcare providers… more
- CareOregon (Medford, OR)
- …contractor and must comply with all federal laws. Job Title Registered Nurse - Care Coordinator (Community) Exemption Status Exempt Department Clinical Services ... order to achieve optimal health and wellness outcomes. Registered Nurse - Care Coordinator is part of an innovative...For Service program benefits). + Report member complaints to Appeals and Grievance team for investigation and follow-up, per… more
- Elevance Health (Latham, NY)
- ** Nurse Medical Management I** **LOCATION** **: This is a remote position working from home; however, you** **must** **be within 50 miles of one of the offices ... NY **HOURS: Monday - Friday, 8:30am - 5:00pm.** The ** Nurse Medical Management I** is responsible to collaborate with...of care and accurate claims payment. May also manage appeals for services denied. **How you will make an… more
- Elevance Health (Tampa, FL)
- ** Nurse Medical Management I** **Preferred Location** : Florida. **This position will work 100% remote (with the exception of team meetings which will be held on a ... miles of one of our Elevance Health PulsePoint locations. ** Nurse Medical Management I** Responsible to collaborate with healthcare...of care and accurate claims payment. May also manage appeals for services denied. **How will you make an… more
- Kepro (Rockingham, NC)
- …expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an ... the Personal Care Services (PCS) program, services are provided to NC Medicaid Beneficiaries who have a medical condition, cognitive impairment, or disability who… more
- Molina Healthcare (MS)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... clinical quality improvement activity (QIA) in collaboration with the clinical lead , the medical director, and quality improvement staff. + Facilitates conformance… more
- Kepro (VA)
- …expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an ... complete needs-based eligibility determinations for patients who are applying for these Medicaid -funded personal care services provided in their home or in adult… more
- Trinity Health (Des Moines, IA)
- …and Medicaid Services (CMS), Iowa Department of Inspections and Appeals (IDIA), The Joint Commission (TJC),etc.), in conjunction with the hospital's leaders, ... administration or related field required. + Iowa licensure as a Registered Nurse . + Member of a professional healthcare organization.Demonstrated expertise in the… more