- US Tech Solutions, Inc. (Columbia, SC)
- …using the individual patient's benefits contract and our medical policies. The nurse would read through clinical information, ensuring that all requirements ... equipment to be prepared. . The position is fully remote after that. . Please list out the top...appeals . Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims… 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 ... basic computer skills is essential for excelling in this remote , production-driven position. **Here's what you will experience working...position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct… more
- R1 RCM (Chicago, IL)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help ... basic computer skills is essential for excelling in this remote production-drive position. **Here's what you will experience working...position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** +… 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
- Elevance Health (Rancho Cordova, 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 ... **Shift:** Monday to Friday from 8:00-5:00 pm PT The ** Nurse Appeals ** is responsible for investigating and.../grievances/quality of care issues and is a resource for clinical and non clinical team members in… more
- Centene Corporation (Austin, TX)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... a candidate who resides in Texas. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals...processes is preferred. **License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required or + LVN -… more
- Molina Healthcare (Florence, KY)
- …management for another MCO is preferred. This position is fully a remote , work from home opportunity.** **Job Summary** Molina Healthcare Services (HCS) works ... compliance with all state and federal regulations and guidelines. + Analyzes clinical service requests from members or providers against evidence based clinical… more
- Sharecare, Inc. (Columbus, OH)
- …or assist member in working with payer to complete prior authorization or appeals process, when necessary. + Abide by Clinical Advocacy Program Description ... for everyone. To learn more, visit www.sharecare.com. **Job Summary:** The Clinical Advocate supports the implementation and delivery of Sharecare's Advocacy program… more
- Prime Therapeutics (Columbus, OH)
- …and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for ... these cases in web-based application and spreadsheets. + Supports clinical services such as the appeals program....provided by the Manager, Patient Programs. **Responsibilities** + Registered Nurse (RN). + 5 years of post-degree clinical… more
- Providence (Vancouver, WA)
- …best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN who will:** + Provide care coordination, case management ... nearing end of life + Care management services include: nurse education, care coordination and general assistance with managing...care to our members **Providence Health Plan welcomes 100% remote work for applicants who reside in the following… more
- State of Colorado (Denver, CO)
- …Less than one year of experience 09 How many years of experience do you have as Nurse Manager, or Clinical Supervisor? + 2 or more years of experience + 1-2 ... Youth Corrections Medical Operations Coordinator ( Nurse V) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4573875) Apply Youth Corrections… more
- State of Colorado (Denver, CO)
- …assigning responsibilities. During specific shifts, functions in the role of Charge Nurse and provides clinical and administrative supervision of nursing staff ... of work, providing clinical leadership and teaching clinical interventions. Functions as the Charge Nurse ,...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)
- Charge Nurse RN II - CO Mental Health Hospital in Fort Logan (S. Denver) *$14,000 Sign On Bonus* Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4556884) Apply Charge Nurse RN II - CO Mental Health Hospital in Fort Logan (S. Denver) *$14,000… more
- State of Colorado (Arapahoe County, CO)
- NURSE II - Marvin Foote - Englewood - TEMP PAY DIFFERENTIAL Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4630902) Apply NURSE II - ... Position. This position is responsible for the direction and clinical supervision of all Nursing and Health Care Technician...health care to detained and committed youth within the nurse 's scope of practice. Primary care is provided by… more
- State of Colorado (Pueblo, CO)
- Registered Nurse I - Division of Youth Services, Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4644804) Apply Registered Nurse I ... shift offered. We have multiple openings. Specific Job Duties: Clinical Duties: Ensures the provision of patient care is...patient care is within standards established by the State Nurse Practice Act and the Division of Youth Services… more
- State of Indiana (Indianapolis, IN)
- Public Health Nurse Specialist Date Posted: Sep 5, 2024 Requisition ID: 449097 Location: Indianapolis, IN, US, 46202 Work for Indiana Begin a fulfilling career with ... live, learn, work, or play. Role Overview: As a Nurse Specialist you will determine medical eligibility of applicants...and the public. This position offers 2 days of remote work each work week (15 total hours). Salary… more
- Magellan Health Services (Honolulu, HI)
- …cost of care. Oversees utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the interaction with claims ... This is a remote /work from home position, but candidates need to...policies and processes. Also oversees the health plans 24/7 Nurse Line program and the clinical management… more
- Elevance Health (Tampa, FL)
- …miles / 1 hour commute of Tampa or Miami, FL offices. This is primarily a remote position but may be required to go in for meetings/training. MUST RESIDE IN THE ... Friday. **2 Holidays** per year and **occasional** weekends. The ** Nurse Medical Management Sr** serves as **team lead** for...of care and accurate claims payment. May also manage appeals for services denied. Primary duties may include, but… more
- Molina Healthcare (New York, NY)
- …and MLTC/LTC experience are highly preferred. Additional experience with appeals , quality review, and experience with data collection/reports.** **_Bilingual ... are encouraged to apply._** **Work hours: Monday - Friday 8:30AM- 5:00PM EST** ** Remote position with light travel- 10-15% for in person meeting at the Bronx… more
- Centene Corporation (Brooklyn, NY)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... + Assist member with filing and resolving complaints and appeals + Direct care to participating network providers +...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
