• Nurse Appeals (RN)

    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
    Elevance Health (11/02/24)
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  • Clinical Appeals Nurse

    R1 RCM (Salt Lake City, UT)
    …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Nurse ** , you will help our hospital clients by ... production-driven position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical records and… more
    R1 RCM (10/30/24)
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  • Appeals & Grievances Nurse

    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
    UCLA Health (10/31/24)
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  • Customer Solution Center Appeals

    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 (11/04/24)
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  • Customer Solution Center Appeals

    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
    LA Care Health Plan (10/11/24)
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  • Appeals Nurse Consultant (Remote)

    CVS Health (Hartford, CT)
    …**Position Summary** Responsible for the review and resolution of clinical appeals . Reviews documentation and interprets data obtained from clinical records to ... as required. This position may support UM, MPO, Coding, or Behavioral Health appeals . **Required Qualifications** + Must have active and unrestricted RN licensure in… more
    CVS Health (11/03/24)
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  • Denials and Appeals Nurse - Full…

    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
    Dayton Children's Hospital (11/05/24)
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  • Manager, Grievance and Appeals , RN

    VNS Health (Manhattan, NY)
    OverviewManages the day to day activities for staff handling of grievances and appeals for one of the following VNS Health Plans product lines - Managed Long Term ... and audits subcontractors who have delegated responsibility for managing grievance and appeals on behalf of the plan to ensure operational and regulatory compliance.… more
    VNS Health (09/04/24)
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  • Grievance and Appeals Specialist, Clinical

    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 ... appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and reporting… more
    VNS Health (09/20/24)
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  • Clinical Appeals Supervisor

    R1 RCM (Detroit, MI)
    …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Supervisor** , you will help support clinicians who conduct a ... comprehensive review of clinical denials and formulate appeals based on clinical documentation, evidence-based medical necessity criteria, physician documentation,… more
    R1 RCM (11/01/24)
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  • Clinical Appeals & Denials Manager

    R1 RCM (Boise, ID)
    …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
    R1 RCM (10/22/24)
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  • Supervisor, Appeals and Grievances Clinical…

    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
    LA Care Health Plan (09/20/24)
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  • Clinical Review Clinician - Appeals

    Centene Corporation (New York, NY)
    …license.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more
    Centene Corporation (11/01/24)
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  • Outpatient Denial/ Appeals Specialist- RN

    Carle (Urbana, IL)
    Outpatient Denial/ Appeals Specialist- RN + Department: Revenue Cycle - CFH_10_19 + Entity: Champaign-Urbana Service Area + Job Category: Clerical/Admin + Employment ... from Home + Weekend Requirements: no + Other Posting Information: Registered Professional Nurse (RN) License Illinois upon hire. + Holiday Requirements: no Email a… more
    Carle (08/23/24)
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  • Appeals Audit Specialist - McLaren Careers

    McLaren Health Care (Bay City, MI)
    …. Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews ... of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and achieve optimal payment for… more
    McLaren Health Care (09/26/24)
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  • Appeals Manager, Department of Utilization…

    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
    BronxCare Health System (09/18/24)
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  • Clinical Appeals Specialist

    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
    CDPHP (10/26/24)
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  • Appeals and Grievance Specialist…

    Baylor Scott & White Health (Temple, TX)
    **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... complaints, appeals and grievance cases for products for all lines...case submissions. + Refers clinical appeal cases to Medical Nurse Auditors or Pharmacy Technicians for handling where required.… more
    Baylor Scott & White Health (10/30/24)
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  • Appeals Pharmacist

    Adecco US, Inc. (Los Angeles, CA)
    Adecco Healthcare & Life Sciences is hiring an Appeals Pharmacist. This role is remote / work from home. Please read below and apply with an updated resume for ... to 5pm PST **Pay:** $70.00 to $73.00 an hour **Responsibilities of the Appeals Pharmacist:** . Collaborates with the coordinators and nurses to process referrals,… more
    Adecco US, Inc. (10/23/24)
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  • Coordinator-RAC TPE - HS Revenue Audit Corporate

    Baptist Memorial (Memphis, TN)
    Summary Medicare / Medicaid Appeals Registered Nurse reviews and evaluates medical documentation to support billing compliance and external regulatory ... Responsibilities + Abstracts pertinent information from the medical record to create appeals for cases denied by governmental payors. + Educates department staff to… more
    Baptist Memorial (09/05/24)
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