- Elevance Health (Los Angeles, 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
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding ... adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all applicable State and Federal rules and… more
- R1 RCM (Boise, ID)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid… 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 ... or Medicare Advantage setting is highly desired * Experience in handling appeals , grievances, utilization management, or potential quality issues * Knowledge of… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II is primarily responsible for the overall… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct… more
- Scripps Health (San Diego, CA)
- …for over 10 years. We invite you to join our Revenue Cycle team as a Registered Nurse of Appeals . * In this role, you will be responsible for the following * ... and system reimbursement. * Responsible for completing government and commercial appeals for systemwide hospital billing. * Understands basic denial rationales and… more
- Dayton Children's Hospital (Dayton, OH)
- …Completion of accredited BSN program required Certifications + Licensed Registered Nurse in Ohio required + Current professional certification in evidence-based care ... experience in a hospital required + 3-5 years as progressive utilization review nurse and knowledge of payers and managed care contracts preferred + Previous program… more
- Trinity Health (Springfield, MA)
- …Shift **Description:** Requires BSN At **Mercy Medical Center** the **Utilization Review/ Appeals & Denials** **RN** performs utilization review with payers, assists ... determinations using screening criteria, and assists the physician, bedside Registered Nurse , ICC and Social Worker with utilization management and clinical… more
- CareFirst (Baltimore, MD)
- …+ Reviews Clinical Appeals and Grievances documentation written by the clinical appeals nurse and non-clinical supporting team members within the Appeals ... **Resp & Qualifications** **PURPOSE:** The role of the Quality Review Nurse (RN) is to evaluate clinical quality and procedures within the Clinical Appeals &… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor (RN) directs and coordinates the accurate implementation of the clinical appeal process for ... the activities and serves as a resource for associates within the Clinical Appeals and Analysis unit supporting Government Programs lines of business. We are looking… 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 ... * Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long Term Care (MLTC), Medicare Advantage (MA), or… more
- CareFirst (Baltimore, MD)
- …and support NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department. We are looking for an experienced people leader ... with dynamic goals resulting in the full and fair review of appeals and designed to achieve corporate objectives and advance departmental capabilities. Accountable… more
- R1 RCM (Chicago, IL)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals and Denials Manager** , you will serve as an expert on ... clinical appeals and denials management. Every day you will support...challenges, and process improvement opportunities. **Required Skills:** + Registered Nurse (active or inactive in good standing and able… more
- University of Virginia (Haymarket, VA)
- …+ Follow the appropriate payor procedures for initiating reviews, reconsiderations and/or appeals . + Follow-up with the payors to assure our requests are responded ... to document root causes, reflect current status within the appeals process to assure our internal customers know at...be considered. Licensure: Licensed to practice as a Registered Nurse in the Commonwealth of Virginia PHYSICAL DEMANDS Job… 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, 90017 ... safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the… more
- BronxCare Health System (Bronx, NY)
- …the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to ... identification of patterns and trends identified during the course of appeals preparation. Conduct departmental performance improvement audits, analyze findings and… more
- CDPHP (Albany, NY)
- …values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and grievance process ... Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations about… more
- HonorHealth (Scottsdale, AZ)
- …medical records documentation and billing statements on patient accounts; submits appeals to payers on patient account denials when appropriate; reviews medical ... appeal is clearly presented. Prioritizes and organizes own work to meet appeals and grievance deadlines. Responsible for the denials process, including subsequent… 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 ... executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB...health plan. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California, Active BLS -… more
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