- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & Grievances ... (A&G) & General Operations ( Clinical ) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals & Grievances… more
- University of Washington (Seattle, WA)
- …**WORK SCHEDULE** + 100% FTE + 100% Remote + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ensures that payers are prepared to ... Financial Services Department** has an outstanding opportunity for a ** Clinical Appeals and Disputes Nurse .**...communicated payer decisions in a timely manner + Review clinical denials and initiate appeals process +… more
- CareFirst (Baltimore, MD)
- …programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Clinical Appeals and Analysis **Equal Employment Opportunity** ... **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial...appropriate referral source communication system. Assigns cases to the nurse for research and completion. Performs file coordination activities… more
- Nuvance Health (Danbury, CT)
- *Description* *FULL TIME DAY SHIFTS- VARIABLE HOURS / WEEKEND ROTATIONS REQUIRED* * *Hybrid/ Remote * * *Summary:* The purpose of the Denial Prevention Nurse is to ... in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- LA Care Health Plan (Los Angeles, CA)
- …in Nursing for Registered Nurses Experience Required: At least 8 years of clinical appeals and grievances experience in a managed care, utilization management ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017… more
- Henry Ford Health System (Troy, MI)
- …GENERAL SUMMARY: Unit Description: Health Alliance Plan (HAP) is looking to grow our Medical Appeals Team with an experienced Registered Nurse ! We are a team of ... RN PROVIDER APPEALS COORDINATOR - MEDICAL APPEALS -...through Friday, 8:00AM to 4:30PM. This position is primarily remote with the possibility of in person meetings and… more
- Northwell Health (Melville, NY)
- …+ Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect ... retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness… more
- Cognizant (Salem, OR)
- …cycle or clinic operations + Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews + ... Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...stand out** + Epic experience + Experience in drafting appeals disputing inpatient clinical validations audits is… more
- Integra Partners (Troy, MI)
- …of UM authorization reviews, both verbally and in writing + Process administrative and clinical appeals and refer as needed to the Medical Director + Maintain ... care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key role in collaborating… more
- State of Colorado (Pueblo, CO)
- Nurse I - RN Critical Incident/Occurrence Reporter-CMHHIP-Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5147450) Apply Nurse I - ... and time listed. + Description + Benefits + Questions Department Information Registered Nurse I-Full Time CMHHIP This position has a residency waiver and will be… 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 ... of work, providing clinical leadership and teaching clinical interventions + Functions as the Charge Nurse...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Denver, CO)
- Charge Nurse RN II (Internal Pool)- CO Mental Health Hospital in Fort Logan (S. Denver) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5125585) ... Apply Charge Nurse RN II (Internal Pool)- 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)
- Off Hours Nurse Supervisor - Nurse III (Internal Pool) - Colorado Mental Health Hospital Fort Logan Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5132944) Apply Off Hours Nurse Supervisor - Nurse III (Internal Pool) - Colorado Mental Health… more
- State of Colorado (Pueblo, CO)
- Nurse Manager- Mid Level Provider - CMHHIP Nursing- Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5171266) Apply Nurse Manager- ... receive text message updates on CDHS recruiting events! CDHSCareers Description of Job The Nurse Manager (NM) works in tandem with other Nurse Managers. The NM… more
- State of Colorado (Pueblo, CO)
- Registered Nurse I - Nursing Residency Program - CMHHIP - Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5145740) Apply Registered ... Nurse I - Nursing Residency Program - CMHHIP -...an evidence-based project to aid learning and build confidence. Clinical Direction: + Responsible for the direction of all… more
- State of Colorado (Pueblo, CO)
- Registered Nurse II- CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5130585) Apply Registered Nurse II- CMHHIP Salary $45.99 - ... and time listed. + Description + Benefits + Questions Department Information Registered Nurse II-Full Time CMHHIP This posting will be used to fill multiple… more
- State of Colorado (Pueblo, CO)
- Nurse I - Registered Nurse I...This position is responsible for assisting nursing staff with clinical direction of nursing staff, QA/PI activities and to ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5130579) Apply Nurse I - Registered Nurse I - CMHHIP Salary $43.80 - $61.31 Hourly Location… more
- State of Colorado (Garfield County, CO)
- NURSE II - Veteran's Community Living Center at Rifle Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5145886) Apply NURSE II - Veteran's ... Duty Description: Performs both admission and daily assessments during clinical stay, identifying critical incidents, emergencies, acute illnesses, and behavior… more
- State of Colorado (Garfield County, CO)
- NURSE I - Veterans Community Living Center at Rifle Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5145850) Apply NURSE I - Veterans ... requirements. + Performs both admission and daily assessments during clinical stay, identifying critical stay, identifying critical incidents, emergencies, acute… more
- State of Colorado (Golden, CO)
- Medical Operations Coordinator ( Nurse V) - Lookout Mountain Youth Services Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5166280) Apply ... Medical Operations Coordinator ( Nurse V) - Lookout Mountain Youth Services Center Salary...level supervisor, contributes to the evaluation of medical and clinical performance of all DYS medical staff as needed,… more
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