- CareFirst (Baltimore, MD)
- …of member and provider disputes regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation… more
- LA Care Health Plan (Los Angeles, CA)
- …with Registered Nurses and Medical Directors to appropriately investigate, review and resolve clinical appeals and grievances. Prepares Nurse Summary for MD ... Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor (RN) directs and coordinates the accurate implementation of the clinical appeal ... that result in quality resolution of member and provider disputes regarding adverse and adverse coverage determinations in accordance...and serves as a resource for associates within the Clinical Appeals and Analysis unit supporting Government… more
- CareFirst (Baltimore, MD)
- …for our membership, and support NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department. We are looking for an experienced ... including (EGWP, DSNP, MAPD). Ensures quality management of the clinical appeal process to reduce the risk of State...goals resulting in the full and fair review of appeals and designed to achieve corporate objectives and advance… more
- Baylor Scott & White Health (Temple, TX)
- …expedited and external case reviews, and prepares final case submissions. + Refers clinical appeal cases to Medical Nurse Auditors or Pharmacy Technicians for ... **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider… 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 ... assuring timely completion of work, providing clinical leadership and teaching clinical interventions. Functions as the Charge Nurse , when assigned, and… more
- State of Colorado (Denver, CO)
- …Rules and Personnel Director's Administrative Procedures , Chapter 8, Resolution of Appeals and Disputes , at spb.colorado.gov under Rules. Supplemental ... Charge Nurse RN II - CO Mental Health Hospital...coordinates and implements medical and psychiatric crisis intervention in clinical emergencies assuring compliance with nursing standards and policies/procedures.… more
- State of Colorado (Denver, CO)
- …Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes , at spb.colorado.gov under Rules. Supplemental ... of the department's action. For more information about the appeals process, the official appeal form, and how to...How many years of experience do you have as Nurse Manager, or Clinical Supervisor? + 2… more
- State of Colorado (Denver, CO)
- …Rules and Personnel Director's Administrative Procedures , Chapter 8, Resolution of Appeals and Disputes , at spb.colorado.gov under Rules. Supplemental ... Charge Nurse RN II - Mental Health Hospital in...This is a vacancy fill. This work leader provides clinical and administrative supervision of 2-5 nursing staff continuously… more
- State of Colorado (CO)
- …CAA Nurse III 2/2024 Department Department of Corrections Division Clinical and Correctional Services Opening Date 02/08/2024 Closing Date 12/31/2024 4:00 PM ... CDOC Nurse Supervisor Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4383689) Apply CDOC ...Personnel Director's Administrative Procedures , Chapter 8, Resolution of Appeals and Disputes , at spb.colorado.gov under… more
- State of Colorado (CO)
- …Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes , at spb.colorado.gov under Rules. Supplemental ... CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4555045) Apply CDOC Registered Nurse ( Nurse I)… more
- State of Colorado (Brighton, CO)
- …Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes , at spb.colorado.gov under Rules. Supplemental ... NURSE I at Prairie Vista Youth Service Center...shift offered. We have multiple openings. Specific Job Duties: Clinical Duties: Ensures the provision of patient care is… more
- State of Colorado (Rifle, CO)
- …Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes , at spb.colorado.gov under Rules. Supplemental ... NURSE II - RIFLE VCLC Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4677214) Apply NURSE II - RIFLE VCLC Salary $45.08 - $63.12 Hourly… more
- State of Colorado (Denver, CO)
- …Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes , at spb.colorado.gov under Rules. Supplemental ... NURSE CONSULTANT Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4715738) Apply NURSE CONSULTANT Salary $98,448.00 - $137,844.00 Annually… more
- Travelers Insurance Company (Tampa, FL)
- …a plus. **What is a Must Have?** + Registered Nurse or Licensed Practical Nurse with Surgical clinical experience. **What Is in It for You?** + **Health ... Imagine loving what you do and where you do it. **Job Category** Claim, Nurse - Medical Case Manager **Compensation Overview** The annual base salary range provided… more
- State of Colorado (Limon, CO)
- …Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes , at spb.colorado.gov under Rules. Supplemental ... of Corrections Mission $25,000 HIRING INCENTIVE FOR FULL TIME CLINICAL PROFESSIONALS! If your goal is to build a...must possess current, valid licensure as an Advanced Practice Nurse / Nurse Practitioner from the Colorado… more
- State of Colorado (Denver, CO)
- …and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes , atspb.colorado.govunder Rules. Supplemental Information How ... and has primary oversight and supervision of the clinic. Job Duties: Clinical Management: Functions as the facility medical authority (RHA). Ensuring that health… more
- State of Colorado (Denver, CO)
- …patients in a clinical setting under the direction of a registered nurse at the Denver reception and Diagnostic Center (DRDC). This position is responsible for, ... but not limited to, the following: + In a clinical setting, assist patients with activities of daily living...and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes , at spb.colorado.gov under Rules.… more
- State of Colorado (Denver, CO)
- …and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes , atspb.colorado.govunder Rules. Supplemental Information Link ... health care including physical, psychiatric, and dental maintenance. Job Duties: Clinical Assessment: Detect and prevent the spread of communicable infectious… more
- State of Colorado (Denver, CO)
- …Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes , at spb.colorado.gov under Rules. Supplemental ... Number CAA P/T Physician 10/2024 Department Department of Corrections Division Clinical and Correctional Services Opening Date 10/28/2024 Closing Date 11/12/2024… more