- CareFirst (Baltimore, MD)
- …organization or hospital. Demonstrated leadership skills. In Lieu of Education. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates...Case Manager Upon Hire Preferred + LNCC - Legal Nurse Consultant Certified Upon Hire Preferred **Preferred Qualifications:** +… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …is eligible for the eWorker persona.The TeamAs an integral part of the Clinical Appeals team, the Appeals Nurse Reviewer will serve as a liaison and ... to help us transform healthcare? Bring your true colors to blue. The RoleThe Appeals Nurse Reviewer is responsible for reviewing provider claims appeals ,… more
- CareFirst (Baltimore, MD)
- …**PURPOSE:** This position will support the government programs line of business. The Clinical Appeals Nurse completes research, basic analysis, and ... provider disputes regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes ...those with substance disorders and addictions. **Licenses/Certifications** : + RN - Registered Nurse -… more
- Molina Healthcare (Columbus, OH)
- … decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- HCA Healthcare (San Antonio, TX)
- **Description** **Introduction** Do you have the career opportunities as a Clinical Appeals Nurse you want with your current employer? We have an exciting ... of colleagues. Do you want to work as a Clinical Appeals Nurse where your...qualifications you will need:** + Currently licensed as a Registered Nurse ( RN ) in the… more
- TEKsystems (Annapolis, MD)
- …with Hybrid (2 Days Onsite/3 Days remote) Description Position Summary The clinical denial appeals specialist is responsible for the identification, mitigation, ... all initial clinical denials to determine next steps and conducts appeals as appropriate, such as by reviewing medical necessity, responding to authorization… more
- R1 RCM (Boise, ID)
- …team members and 1:1 meetings on a routine basis. **Required Skills:** + Active Registered Nurse license + Active AHIMA or AAPC Coding Certification including ... analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Supervisor** , you will support clinical coders… more
- R1 RCM (Detroit, MI)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** +...external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + An active CCS,… more
- Centene Corporation (Sacramento, CA)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... UM Experience, and be able to work Pacific Hours.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical… more
- Hartford HealthCare (Wethersfield, CT)
- …to identified patterns 9. Other duties as assigned. *_Reports To:_*Manager, Clinical Resource Management *_Education:_* Registered Nurse . Bachelors of ... rapidly changing medical environment. *_Position Summary:_* The Denial and Appeals Nurse is an integral part of...**Job:** **Other* **Organization:** **Hartford HealthCare Corp.* **Title:** *Denial and Appeals RN / Clinical Resource… more
- LA Care Health Plan (Los Angeles, CA)
- …an enthusiastic team player. Must be able to work independently. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US,… more
- VNS Health (Manhattan, NY)
- …Will Do + Responsible for direct oversight and the day to day management of clinical appeals review processes within Appeals & Grievances Department. + ... Health Plans is seeking a dedicated Manager, Grievance and Appeals ( RN )to lead the daily operations of...+ License and current registration to practice as a registered professional nurse in New York State… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Appeals Specialist II, under the direction of the Director of Denial Support Services, logs and reviews per documentation guidelines for report ... software, spreadsheet software and database software. **Licenses and Certifications** + RN -BC - Certified General Nursing Practice current license to practice in… more
- Healthfirst (AL)
- …degree + Case management/care management -QOC experience preferred + Experience in clinical practice with experience in appeals & grievances, claims processing, ... and Responsibilities: + Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity,… more
- LA Care Health Plan (Los Angeles, CA)
- …The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse ( RN ) II provides direct assistance to member's with ... Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC...agencies. Good working knowledge of regulatory requirements/standards. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Catholic Health Services (Melville, NY)
- …named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals ... Responsibilities include but not limited to: |Receives, manages and provides clinical reviews and/or submissions as required by contractual or regulatory… more
- Independent Health (Buffalo, NY)
- …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... Coder (CIC), Registered Health Information Management Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Clinical Documentation… more
- BrightSpring Health Services (Louisville, KY)
- …management. This position will also support detailed level reporting and analytics, clinical appeals , root cause analysis, and address identified trends in ... Denials Management and Audit supervises a team of RN /LPN clinical reviewers as well as Support...as well as Support staff managing all areas of clinical claim pre and post audit, appeals … more
- Premera Blue Cross (Mountlake Terrace, WA)
- …Technology). **(Required)** + Registered Nurse , Physician's Assistant, or Nurse Practitioner with five (5) years' clinical experience. **(Required)** + ... into summary statements for inclusion in policy documents. + Liaise with Clinical Appeals Department to regularly review data from same specialty and independent… more
- ManpowerGroup (Columbia, SC)
- …industry, is seeking an Analyst, Appeals to join their team. As an Analyst, Appeals , you will be part of the clinical review department supporting the ... regulations or standards. + Perform thorough research of service appeals based on clinical documentation, contractual requirements,...quality assurance, or home health. + An active, unrestricted RN license from the United States and in the… more