- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The RoleThe Appeals Nurse Reviewer is responsible for reviewing provider claims appeals , ... eWorker persona.The TeamAs an integral part of the Clinical Appeals team, the Appeals Nurse ...comprehensive package of benefits including paid time off, medical/dental/vision insurance , 401(k), and a suite of well-being benefits to… more
- Elevance Health (Walnut Creek, CA)
- ** Nurse Appeals - Licensed RN Nurse ** **Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live in the state of ... our PulsePoint locations. **Shift:** Monday to Friday from 8:00am-5:00pm **PST** The ** Nurse Appeals ** is responsible for investigating and processing medical… more
- Molina Healthcare (Columbus, OH)
- …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...Chief Medical Officer for Administrative Law Judge pre-hearings, State Insurance Commission, and Meet and Confers. + Represents Molina… more
- TEKsystems (Rancho Cucamonga, CA)
- Grievance & Appeals Nurse (Hybrid - Rancho Cucamonga, CA) Pay: $31/hr Location: Hybrid - Rancho Cucamonga, CA 91730 Are you a dedicated Licensed Vocational ... to make an impact? We're hiring a Grievance & Appeals Nurse to ensure that healthcare cases...Plan - Pre-tax and Roth post-tax contributions available* Life Insurance (Voluntary Life & AD&D for the employee and… more
- US Tech Solutions (Columbia, SC)
- …moved to work remote. Equipment will be provided. + Prefer 2 yrs. UM and/or appeals experience. We want to see all candidates with experience with prior insurance ... standards. Performs thorough research of the substance of service appeals by both member and provider based on clinical...Accreditation Commission (URAC). Knowledge of South Carolina Department of Insurance (SCDOI). Knowledge of US DOL and Health … more
- VNS Health (Manhattan, NY)
- …complexities of healthcare? VNS Health Plans is seeking a dedicated Manager, Grievance and Appeals (RN)to lead the daily operations of our grievance and appeals ... Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long Term Care (MLTC), Medicare...paid time off and 9 company holidays + Health insurance plan for you and your loved ones, Medical,… more
- CareFirst (Baltimore, MD)
- …as needed. Reviews, researches problematic correspondence and works on special projects with Appeals Nurse or Management. + Interacts regularly with and responds ... in settings such as managed care, health care or insurance payor environment. 2 years experience in Appeals... insurance payor environment. 2 years experience in Appeals Management. **Preferred Qualifications** : + College Degree +… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage ... decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and...paid time off and 9 company holidays + Health insurance plan for you and your loved ones, Medical,… more
- Centene Corporation (Jefferson City, MO)
- …duties as assigned + Complies with all policies and standards **Registered Nurse with behavioral health and Medicare appeals experience preferred.** ... **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical… more
- Centene Corporation (Austin, TX)
- …_** Position Purpose: Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity ... of utilization management processes preferred. License/Certification: LPN - Licensed Practical Nurse - State Licensure required or LVN - Licensed Vocational … more
- State of Colorado (Centennial, CO)
- Registered Nurse I - Marvin Foote Youth Services Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4819409) Apply Registered Nurse I ... of Position: Delivers health care to detained and committed youth within the nurse 's scope of practice. Primary care is provided by independent practitioners with… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4762850) Apply CDOC Registered Nurse ( Nurse I) ... Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 01/2025 Department Department of Corrections Division...+ Medical and Dental Health Plans; + Paid life insurance ; + Short and long-term disability coverage; + 11… more
- State of Colorado (Denver, CO)
- Youth Corrections Medical Operations Coordinator ( Nurse V) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4573875) Apply Youth Corrections ... Medical Operations Coordinator ( Nurse V) Salary $108,540.00 - $151,968.00 Annually Location Denver...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)
- Assistant Nurse Manager - Nurse III -...of the department's action. For more information about the appeals process, the official appeal form, and how to ... Fort Logan (S. Denver) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4826298) Apply Assistant Nurse Manager - Nurse III - Colorado… more
- State of Colorado (Denver, CO)
- CDOC Registered Nurse - Part-time - Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4829308) Apply CDOC Registered Nurse - ... Denver, CO Job Type Part Time Job Number CAA Nurse I 8212 02/2025 Department Department of Corrections Division...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (CO)
- CDOC Nurse Supervisor Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4764859) Apply CDOC Nurse Supervisor Salary $8,204.00 - $11,487.00 ... Statewide, CO Job Type Full Time Job Number CAA Nurse III 01/2025 Department Department of Corrections Division Clinical...PERA benefits. + Medical and Dental; + Paid life insurance ; + Short and long-term disability coverage; + 11… more
- State of Colorado (Garfield County, CO)
- NURSE I - Veterans Community Living Center at...of the department's action. For more information about the appeals process, the official appeal form, and how to ... Rifle Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4596826) Apply NURSE I - Veterans Community Living Center at Rifle Salary $42.94 Hourly… more
- State of Colorado (Denver, CO)
- Registered Nurse I-$14,000 SIGN ON BONUS Colorado Mental Health Hospital in Fort Logan-Denver Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4822746) Apply Registered Nurse I-$14,000 SIGN ON BONUS Colorado Mental Health Hospital in Fort… more
- State of Colorado (Limon, CO)
- CDOC Licensed Practical Nurse (LPN) -- Limon Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4748844) Apply CDOC Licensed Practical Nurse ... eligible for increased PERA benefits; + Medical and Dentalhealth plans; + Paid life insurance ; + Short and long-term disability coverage; + 11 paid holidays per year… more
- State of Colorado (Rio Grande County, CO)
- Nurse II - Homelake VCLC Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4740861) Apply Nurse II - Homelake VCLC Salary $45.08 Hourly ... life and love abound. Description of Job As a Nurse II. this position exists to provide professional nursing...of the department's action. For more information about the appeals process, the official appeal form, and how to… more