- Maximus (New York, NY)
- … Clinical Adjudicator - LPN to join our QIC DME team. This is a remote opportunity. The Clinical Adjudicator - LPN is responsible for medical reviews and ... applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals , following project guidelines. Essential...to 4:30pm EST Minimum Requirements - Current Licensed Practical Nurse (LPN) license valid in the state of practice… more
- R1 RCM (Salt Lake City, UT)
- …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help our ... basic computer skills is essential for excelling in this remote , production-driven position. **Here's what you will experience working...position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct… more
- R1 RCM (Chicago, IL)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help ... basic computer skills is essential for excelling in this remote production-drive position. **Here's what you will experience working...position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** +… more
- CVS Health (Hartford, CT)
- …zone of residence. **Position Summary** Responsible for the review and resolution of clinical appeals . Reviews documentation and interprets data obtained from ... active and unrestricted RN licensure in state of residence + 3+ years clinical experience **Preferred Qualifications** + Appeals Experience + Managed Care… 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, ... safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II… more
- Elevance Health (Rancho Cordova, 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 ... **Shift:** Monday to Friday from 8:00-5:00 pm PT The ** Nurse Appeals ** is responsible for investigating and.../grievances/quality of care issues and is a resource for clinical and non clinical team members in… more
- Centene Corporation (Austin, TX)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... a candidate who resides in Texas. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals...processes is preferred. **License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required or + LVN -… more
- Sharecare, Inc. (Columbus, OH)
- …or assist member in working with payer to complete prior authorization or appeals process, when necessary. + Abide by Clinical Advocacy Program Description ... for everyone. To learn more, visit www.sharecare.com. **Job Summary:** The Clinical Advocate supports the implementation and delivery of Sharecare's Advocacy program… more
- Providence (Vancouver, WA)
- …best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN who will:** + Provide care coordination, case management ... nearing end of life + Care management services include: nurse education, care coordination and general assistance with managing...care to our members **Providence Health Plan welcomes 100% remote work for applicants who reside in the following… more
- State of Colorado (Denver, CO)
- …Less than one year of experience 09 How many years of experience do you have as Nurse Manager, or Clinical Supervisor? + 2 or more years of experience + 1-2 ... Youth Corrections Medical Operations Coordinator ( Nurse V) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4573875) Apply Youth Corrections… more
- State of Colorado (Denver, CO)
- …assigning responsibilities. During specific shifts, functions in the role of Charge Nurse and provides clinical and administrative supervision of nursing staff ... of work, providing clinical leadership and teaching clinical interventions. Functions as the Charge Nurse ,...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)
- Charge Nurse RN II - CO Mental Health Hospital in Fort Logan (S. Denver) *$14,000 Sign On Bonus* Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4556884) Apply Charge Nurse RN II - CO Mental Health Hospital in Fort Logan (S. Denver) *$14,000… more
- State of Colorado (Arapahoe County, CO)
- NURSE II - Marvin Foote - Englewood - TEMP PAY DIFFERENTIAL Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4630902) Apply NURSE II - ... Position. This position is responsible for the direction and clinical supervision of all Nursing and Health Care Technician...health care to detained and committed youth within the nurse 's scope of practice. Primary care is provided by… more
- State of Colorado (Pueblo, CO)
- Registered Nurse I - Division of Youth Services, Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4644804) Apply Registered Nurse I ... shift offered. We have multiple openings. Specific Job Duties: Clinical Duties: Ensures the provision of patient care is...patient care is within standards established by the State Nurse Practice Act and the Division of Youth Services… more
- Banner Health (AZ)
- …Arizona **Department Name:** PHSO Med Claims Review **Work Shift:** Day **Job Category:** Clinical Care The future is full of possibilities. At Banner Plans & ... your experience and skills to BPN. As a Registered Nurse Auditor, you will serve as a vital part...educational resource for the team. This position is fully remote , with a four-day workweek, 10 hours each day,… more
- State of Indiana (Indianapolis, IN)
- Public Health Nurse Specialist Date Posted: Sep 5, 2024 Requisition ID: 449097 Location: Indianapolis, IN, US, 46202 Work for Indiana Begin a fulfilling career with ... live, learn, work, or play. Role Overview: As a Nurse Specialist you will determine medical eligibility of applicants...and the public. This position offers 2 days of remote work each work week (15 total hours). Salary… more
- Elevance Health (Los Angeles, CA)
- ** Nurse Medical Management I** **Location:** Las Vegas, NV; Seattle, WA & Woodland Hills, CA. This position will work a hybrid model ( remote and office) and ... may be required to work some weekend shifts. The ** Nurse Medical Management I** will be responsible to collaborate...of care and accurate claims payment. May also manage appeals for services denied. **How you will make an… more
- Magellan Health Services (Honolulu, HI)
- …cost of care. Oversees utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the interaction with claims ... This is a remote /work from home position, but candidates need to...policies and processes. Also oversees the health plans 24/7 Nurse Line program and the clinical management… more
- Elevance Health (Tampa, FL)
- …miles / 1 hour commute of Tampa or Miami, FL offices. This is primarily a remote position but may be required to go in for meetings/training. MUST RESIDE IN THE ... Friday. **2 Holidays** per year and **occasional** weekends. The ** Nurse Medical Management Sr** serves as **team lead** for...of care and accurate claims payment. May also manage appeals for services denied. Primary duties may include, but… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …retrospective claim review, special review requests, and UM pre\-certifications and appeals , utilizing medical appropriateness criteria, clinical judgement, and ... the Medical Director when appropriate, according to policy\. + Assists non\- clinical staff in performance of administrative reviews + Performing comprehensive… more
