- R1 RCM (Salt Lake City, UT)
- …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
- Northwell Health (Melville, NY)
- …stay. Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately ... retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness… more
- Elevance Health (Costa Mesa, CA)
- ** Nurse Appeals - Licensed RN Nurse.../grievances/quality of care issues and is a resource for clinical and non clinical team members in expediting ... our PulsePoint locations. **Shift:** Monday to Friday from 8:00am-5:00pm PST The ** Nurse Appeals ** is responsible for investigating and processing medical… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate implementation of the clinical appeal process for ... and serves as a resource for associates within the Clinical Appeals and Analysis unit. We are...3 years supervisory experience. **Licenses/Certifications** + RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon… 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
- R1 RCM (Detroit, MI)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Supervisor** , you will help support clinicians ... position. **Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor...additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay… more
- UCLA Health (Los Angeles, CA)
- Description As the Appeals & Grievances Nurse , you will play a key role in managing and resolving New Century Health Plan member appeals and grievances. You ... and thorough review of member and provider complaints, working closely with clinical and administrative teams. + Assessing cases to determine the appropriateness of… 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, ... the safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing… more
- CVS Health (Hartford, CT)
- …zone of residence. **Position Summary** Responsible for the review and resolution of clinical appeals . Reviews documentation and interprets data obtained from ... active and unrestricted RN licensure in state of residence + 3+ years clinical experience **Preferred Qualifications** + Appeals Experience + Managed Care… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES...health plan. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California, Active BLS -… more
- Evolent (Columbus, OH)
- …Join a mission with a company behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact ... policies and procedures while complying with timeliness guidelines. Our clinical nurse reviewer team values collaboration, continuous...Required and Preferred** : + 1-3 years' experience in clinical Appeals Review and is an LPN… 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 our grievance...quality of care concerns and any other inquires requiring clinical review for medical necessity, appropriateness of service or… more
- Baylor Scott & White Health (Temple, TX)
- …the appropriateness of services. **ESSENTIAL FUNCTIONS OF THE ROLE** + Reviews clinical information for appeals and grievances (pre- and post-service denials) ... position type and/or level **JOB SUMMARY** **HYBRID POSITION** The Appeals & Grievances (Medical Auditor) RN conducts reviews of...orientation and ongoing education of new department employees. + Clinical acumen to critically think and be able to… 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...within operational aspects, of the member and provider complaints, appeals and grievance cases for products for all lines… more
- Elevance Health (Louisville, KY)
- ** Clinical Review Nurse I** **National Government...carries. **How you will make an Impact:** + The Nurse Appeals is responsible for investigating and ... 5 pm EST or CST. Hours are flexible.** The ** Clinical Review Nurse I** is responsible for...processing medical necessity appeals requests from beneficiaries and providers + Conducts investigations… more
- City and County of San Francisco (San Francisco, CA)
- …and assists with designing and implementing plans for meeting such needs. The Clinical Nurse Specialist (Critical Care) performs other related duties as ... by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- Select Medical (Los Angeles, CA)
- …Century City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) **Pay Rate: $50 - $58.65 ... process. The primary job functions in Case Management include: Clinical Interventions/Discharge and Care Planning Management; Fiscal Management; and Payer/Referral… more
- Johns Hopkins University (Baltimore, MD)
- …in the Johns Hopkins system. + Experience with EPIC. Classified Title: Clinical Nurse Role/Level/Range: ACRP/03/ME Starting Salary Range: $64,600 - $113,300 ... The Department of Medicine is seeking a **_Clinical Nurse_** to coordinate clinical activities and provide nursing case management services to patients across… more
- State of Colorado (Denver, CO)
- …Less than one year of experience 10 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 (CO)
- …CAA Nurse III 01/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 12/17/2024 Closing Date 6/30/2025 4:00 PM ... CDOC Nurse Supervisor Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4764859) Apply CDOC Nurse Supervisor Salary $8,204.00 - $11,487.00… more
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