- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role BHPS provides Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical ... any time with or without notice. Primary Responsibilities + Review and analyze denials of initial preservice medical...and Complex Care Needs. Essential Qualifications + Current licensed Registered Nurse ( RN ) with state… more
- Centene Corporation (Jefferson City, MO)
- …State Licensure required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... PREFERRED **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine… more
- Centene Corporation (Sacramento, CA)
- …State Licensure required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… more
- Trinity Health (Darby, PA)
- …processing and accuracy of patient stay claims data, denials management, and appeals . Assists RN Manager with establishing tools, processes, policies, procedure, ... reviews in accordance with state guidelines + Ensures timely review of appeals including case preparation with...medical necessity + Other duties as assigned by RN Manager and Director of Care Coordination **Our Commitment… more
- Centene Corporation (New York, NY)
- …experience. Proficient with Microsoft Office applications. Experience with utilization or appeals review preferred. Knowledge of InterQual criteria preferred. ... including a fresh perspective on workplace flexibility. This position requires NY RN Licensure. Daily responsibilities include researching medical history and… more
- LA Care Health Plan (Los Angeles, CA)
- …Care Health Plan members under the direct supervision and management of the A&G Nurse Specialist, RN and/or Medical Director. This position provides ... Business. Duties Works with Registered Nurses and Medical Directors to appropriately investigate, review and...to appropriately investigate, review and resolve clinical appeals and grievances. Prepares Nurse Summary for… more
- R1 RCM (Boise, ID)
- …orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to draft appeals of denied and underpaid ... experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical...external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + Active AHIMA or… more
- Trinity Health (Syracuse, NY)
- …appropriate discharge plan for the patients within their service area. The Registered Nurse Manager is accountable for applying positive managerial strategies ... use of health care resources via pre- and post-service review , appeals and program and network referrals....accredited School of Nursing and current licensure as a Registered Nurse in New York State. +… more
- City and County of San Francisco (San Francisco, CA)
- …may result in dismissal and/or termination of employment. * California Registered Nurse ( RN ) Licenses (http://www. rn .ca.gov/) ... Possession of a valid permanent/temporary (including interim permit) California Registered Nurse License issued by the California...under Civil Service Rule 111A.35.1. The standard for the review of such appeals is 'abuse of… more
- Molina Healthcare (New York, NY)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... eligible for Medicaid .** **We are looking for a RN Care Review Clinician with Prior Authorization...and MLTC/LTC experience are highly preferred. Additional experience with appeals , quality review , and experience with data… more
- Ascension Health (Pensacola, FL)
- …rules and regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Florida Board of Nursing ... obtained prior to hire dateor job transfer date required. Licensed as a Registered Nurse in Florida required. Credentialed from State Board ofNursing or current… 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") ... on medical -related questions raised by the Claim Review and Appeals teams (DOJ and contractor...needed for trainings and meetings. **Qualifications** + Must be Registered Nurse or Nurse Practitioner… more
- Ascension Health (Minooka, IL)
- …management rules and regulations. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Illinois Board of Nursing ... cases. + Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement, and claim denials/ appeals . +… more
- Ascension Health (Manhattan, KS)
- …rules and regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Kansas Board of Nursing ... cases. + Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals . +… more
- University of Virginia (Charlottesville, VA)
- …2 years acute care hospital experience. Licensure: Licensed to Practice as a Registered Nurse in the Commonwealth of Virginia required. PREFERRED QUALIFICATIONS: ... to promote and adhere to regulatory compliance. The UM RN conducts initial concurrent and retrospective medical ...to determine if denied cases will be appealed utilizing medical contract and payroll rules + Conducts appeals… more
- Walgreens (Deerfield, IL)
- …"An Equal Opportunity Employer, including disability/veterans". **Job ID:** 1405241BR **Title:** Registered Nurse ( RN ) Specialty - Remote **Company ... to defined medications. Evaluates all requests for prior authorizations, appeals and accompanying tasks. + Provides nursing network subject...Associate's degree in Nursing + Current license/registration as an RN ( Registered Nurse ) with the… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4555045) Apply CDOC Registered Nurse ( Nurse ... + Benefits + Questions Department Information *Waiver is in place for the Registered Nurse license requirement: Employment is contingent upon valid licensure as… more
- State of Colorado (Chaffee County, CO)
- CDOC Registered Nurse - Part-time - Buena Vista Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4564337) Apply CDOC Registered ... and staff instruction; + Assists physicians, physician assistants, and nurse practitioners with minor medical and surgical...Applicant must possess a current, valid license as a Registered Nurse from the Colorado Board of… more
- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, July 1, 2024 Centers Plan for Healthy Living's goal is to ... JOB SUMMARY: The Grievance & Appeal Clinical Reviewer performs complex medical necessity reviewed on Initial Adverse Determinations or Organization Determinations… more
- Sacramento County (Sacramento, CA)
- Supervising Registered Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448883) Apply Supervising Registered Nurse ... are at 5:00 pm on: 2/5/24, 4/2/24, 6/3/24, 8/5/24, 10/7/24, 12/2/24 Supervising Registered Nurse - Detention/Correctional Facility is the first level supervisory… more