- 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 ... a typical day would like in this role: The nurse would work remotely from their home reviewing authorization...appeals . Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims… more
- Compass Health Network (Arnold, MO)
- …interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion" ... our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our...ensure our clients are taken care of. An Outpatient Nurse will have a Monday through Friday schedule with… more
- Compass Health Network (Raymore, MO)
- …interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion" ... our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our...ensure our clients are taken care of. An Outpatient Nurse will have a Monday through Friday schedule with… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- Job Category:Nursing - Registered Nurse Work Shift/Schedule:VariesNortheast Georgia Health System is rooted in a foundation of improving the health of our ... accountability of the licensed staff who provide services to patients. Provides clinical oversight and training in collaboration with the Department Educator and… more
- Compass Health Network (Jefferson City, MO)
- …interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion" ... our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our...ensure our clients are taken care of. An Outpatient Nurse will have a Monday through Friday schedule with… more
- Compass Health Network (St. Charles, MO)
- …interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion" ... to best serve our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our clients are taken care… more
- Compass Health Network (St. Charles, MO)
- …interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion" ... to best serve our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our clients are taken care… more
- VNS Health (Manhattan, NY)
- …(LCSW) in New York State or other independent licensure (LMHC, LMFT, clinical psychologist, or psychiatric Nurse Practitioner). requiredLicensure in other states ... VNS Health is seeking a Social Work Licensed Clinical Social Worker for a job in Manhattan,...BH QM/UM and performance improvement activities, encompassing grievances and appeals , and contributes to various other subcommittees such as… more
- Accounting Now (Tampa, FL)
- The Denials Specialist performs advanced-level work related to clinical and coding denial management and appeals follow-upThe individual is responsible for ... and appeal processes and escalates timely filing requests to LeadershipCollaborates with Clinical Denials Nurse , Coding Denials Specialists, and Leadership in… 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 ... remote, production-driven position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical… more
- Molina Healthcare (Georgetown, KY)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions… more
- R1 RCM (Chicago, IL)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help ... remote production-drive position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to… 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.../grievances/quality of care issues and is a resource for clinical and non clinical team members in expediting ... locations. **Shift:** Monday to Friday from 8:00-5:00 pm PT The ** Nurse Appeals ** is responsible for investigating and processing medical necessity appeals… more
- Elevance Health (Los Angeles, CA)
- ** Nurse Appeals - California candidates only**.../grievances/quality of care issues and is a resource for clinical and non clinical team members in ... **Schedule: Tuesday - Saturday 9:00am to 5:30 pm PST.** The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- CareFirst (Baltimore, MD)
- …programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Clinical Appeals and Analysis **Equal Employment Opportunity** ... all lines of business. 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
- 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
- HCA Healthcare (Nashville, TN)
- …our 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 ... in our organization. We are looking for an enthusiastic Clinical Appeals Team Lead to help us...Unlock your potential! **Job Summary and Qualifications** The Compliance Nurse Team Lead is responsible for providing clinical… more
- CDPHP (Albany, NY)
- …share these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and ... Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations… more
- Genesis Healthcare (Philadelphia, PA)
- …to be paid. RESPONSIBILITIES/ACCOUNTABILITIES: Reviews patient medical records; utilize clinical , regulatory knowledge and skills to provide convincing appeal ... be in breach of published regulations or payer policy guidelines.Uses clinical evidence and/or regulatory arguments to prove appeal reasoning.Participates in… more
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