- CareFirst (Baltimore, MD)
- …+ CCM - Certified Case Manager Upon Hire Preferred. + LNCC - Legal Nurse Consultant Certified Upon Hire Preferred. **Experience:** + 5 years medical-surgical or ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor (RN) directs and coordinates the accurate...School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon… more
- CareFirst (Baltimore, MD)
- …leadership experience. + Master's in Science Nursing or related field, Legal Nurse Consultant , Utilization Management, and Government Program experience with ... and support NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department. We are looking for an experienced people leader… 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
- State of Colorado (Denver, CO)
- Nurse Consultant RN, Acute Services Care - HFEMS FAA01510 Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4795310) Apply Nurse ... the time of applying. CLASS CODE & CLASSIFICATION DESCRIPTION: Nurse Consultant (C7E1XX) (https://drive.google.com/file/d/0B4enHpLSVk4eajNhUHpKSDVWV3M/view?resourcekey=0-yHO8ucbKmJFk4ciqC9VniQ) This position will… more
- CVS Health (Oklahoma City, OK)
- …+ 5+ years of clinical experience + 2+ years of experience as a Registered Nurse + Must have active current and unrestricted RN licensure in state of residence + ... experience + Claims processing experience + Precertification experience + Clinical Appeals experience + Quality management experience + Experience using Microsoft… more
- Sacramento County (Sacramento, CA)
- Registered Nurse D/CF (Level I/II) Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/454059) Apply Registered Nurse D/CF (Level I/II) ... at 5:00 pm on: 11/5/2024, 1/2/2025, 3/6/2025, 5/8/2025, 7/3/2025, 9/4/2025, 11/6/2025 Registered Nurse D/CF Level I: $61.27 - $74.48 hourly Registered Nurse D/CF… more
- Sacramento County (Sacramento, CA)
- Licensed Vocational Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448956) Apply Licensed Vocational Nurse D/CF Salary ... 4/4/2025, 7/3/2025, 10/3/2025 In a detention/correctional facility, the Licensed Vocational Nurse D/CF performs a wide variety of vocational nursing duties,… more
- MaineGeneral Health (Waterville, ME)
- …patients and their families. MaineGeneral Hospice is currently seeking an experienced Registered Nurse (RN) for a 32-40 hour per week position. The Hospice Quality ... outcomes and satisfaction, compliance, cost, and reimbursement. Serves as a consultant /mentor for staff in areas of documentation, clinical practice and professional… more
- Defense Health Agency (Edinburgh, IN)
- …the Medical Evaluation Board (MEB) Clinical Psychologist subject matter expert and consultant for the development of the psychiatric portion of the Narrative Summary ... and is called upon to serve as an adviser, consultant , or resource person to other providers and inter-disciplinary...medical boards for behavioral health conditions, responds to NARSUM appeals , and addresses questions raised on review by the… more
- Sacramento County (Sacramento, CA)
- …of California to practice as a: Either: 1. Psychiatric Technician Or: 2. Registered Nurse Or: 3. Vocational Nurse Note: The word "experience" referenced in the ... language other than standard English; and/or act as a consultant to others regarding the needs and problems presented...Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days… more
- Clark County, NV (Las Vegas, NV)
- …and oversees the work of contract professionals; negotiates and administers consultant contracts. Coordinates and assists in the processing of applications submitted ... retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and...applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +… more
- Alameda Health System (Oakland, CA)
- …and internal compliance studies. + Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals . ... and/or techniques. + Review cases regularly with staff; acts as clinical consultant regarding care management issues; guides clinical staff with review of… more
- Clark County, NV (Las Vegas, NV)
- …Pharmacy Benefits (30, 90-day retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and Dispatch Health + Retiree ... applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +...in a public setting, working as an air quality consultant , industrial air quality professional or working at a… more
- City and County of San Francisco (San Francisco, CA)
- …of experience as a Licensed Psychiatric Technician or a Licensed Vocational Nurse providing psychiatric nursing care in a skilled facility or psychiatric acute ... permanent or temporary (including an interim permit) California Licensed Vocational Nurse License or Licensed Psychiatric Technician License. Applicants must meet… more
- Centene Corporation (Tallahassee, FL)
- …Develop and maintain the audit process and tools related to: authorizations, appeals , quality events, and case management in CCMS; interrater reliability related to ... compliance with the auditing process + Act as a consultant related to system auditing to others in the...Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), Registered Nurse (RN), or Licensed Psychologist (Ph.D. or Psy.D.) This… more
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