- St. Luke's University Health Network (Allentown, PA)
- …ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... more
- VNS Health (Manhattan, NY)
- …Do + Responsible for direct oversight and the day to day management of clinical appeals review processes within Appeals & Grievances Department. + Manages ... more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- … Appeals Nurse Reviewer is responsible for reviewing provider claims appeals , validating coding and medical necessity of the services submitted and ... more
- AmeriHealth Caritas (Philadelphia, PA)
- …+ Process appeals ensuring compliance with all regulatory milestones. + Review medical records to identify Hospital Acquired Conditions (HAC), ensuring ... more
- Healthfirst (NY)
- …to reduce errors and improve processes and performance to ensure quality. + Review and investigate appeals and grievances requests to ensure all requests ... more
- ManpowerGroup (Columbia, SC)
- …School of Nursing. + 2 years clinical experience plus 1 year in utilization/ medical review , quality assurance, or home health. + An active, unrestricted ... more
- R1 RCM (Detroit, MI)
- …orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to draft appeals of denied and underpaid ... more
- R1 RCM (Chicago, IL)
- …team members and 1:1 meetings on a routine basis. **Required Skills:** + Active Registered Nurse license + Active AHIMA or AAPC Coding Certification including ... more
- CDPHP (Albany, NY)
- …Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations ... more
- CVS Health (Hartford, CT)
- …all with heart, each and every day. **Position Summary** Responsible for the review and resolution of clinical appeals . Reviews documentation and interprets data ... more
- Nuvance Health (Danbury, CT)
- …in nursing, health administration, or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience ... more
- State of Colorado (Golden, CO)
- Registered Nurse I, RN I - Campus at Lookout Mountain, Youth Services Center - Golden Print ... more
- Ascension Health (Destin, FL)
- …rules and regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Florida Board of Nursing ... more
- Amentum (Washington, DC)
- …September 11th Victim Compensation Fund ("VCF") has requirements for one (1) registered nurse to serve on the Claim Review Team and Private Physician ("PP") ... more
- UPMC (Pittsburgh, PA)
- …and operations for all UM functions (prior authorization, concurrent review , appeals and grievances) to ensure effective medical management to deliver high ... 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 ... more
- State of Colorado (Sterling, CO)
- CDOC Registered Nurse - Part-time - Sterling Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4756062) Apply CDOC Registered Nurse ... more
- Sacramento County (Sacramento, CA)
- Supervising Registered Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448883) Apply Supervising Registered Nurse ... more
- Sacramento County (Sacramento, CA)
- …read and understood the above instructions. 02 Select the one box that best describes your Registered Nurse ( RN ) license issued by the State of California. + ... more
- Ascension Health (Baltimore, MD)
- …management rules and regulations. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Maryland Board of Nursing ... more