- R1 RCM (Detroit, MI)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Supervisor** , you will help support clinicians ... position. **Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor...for additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position,… more
- R1 RCM (Boise, ID)
- …encompassing 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...trends, challenges, and process improvement opportunities. **Required Skills:** + Registered Nurse (active or inactive in good… 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 ... position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct...at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position,… more
- CDPHP (Albany, NY)
- …share these 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 ... of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity...external review, and making recommendations for change. QUALIFICATIONS: + Registered Nurse , Physician Assistant or Nurse… more
- RWJBarnabas Health (Oceanport, NJ)
- Clinical Appeals , RN , RemoteReq #:0000173624 Category:Billing/Collections/Registration Status:Full-Time Shift:Day Facility:RWJBarnabas Health Corporate ... is an integral part of our company's success. The RN of Appeals within the RWJ Barnabas...medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted.… more
- Centene Corporation (New York, NY)
- …State Licensure required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best… 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, October 7, 2024 Centers Plan for Healthy Living's goal ... both verbally and in writing. + Analyze and complete written summaries on clinical cases. EDUCATION AND EXPERIENCE: Education: RN required. Required: RN… more
- LA Care Health Plan (Los Angeles, CA)
- …an enthusiastic team player. Must be able to work independently. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US,… more
- VNS Health (Manhattan, NY)
- …Will Do + Responsible for direct oversight and the day to day management of clinical appeals review processes within Appeals & Grievances Department. + ... to day activities for staff handling of grievances and appeals for one of the following VNS Health Plans...+ License and current registration to practice as a registered professional nurse in New York State… more
- LA Care Health Plan (Los Angeles, CA)
- … Registered Nurses and Medical Directors to appropriately investigate, review and resolve clinical appeals and grievances. Prepares Nurse Summary for MD ... Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical...under the direct supervision and management of the A&G Nurse Specialist, RN and/or Medical Director. This… 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 ... . **Required Qualifications** + Must have active and unrestricted RN licensure in state of residence + 3+ years... licensure in state of residence + 3+ years clinical experience **Preferred Qualifications** + Appeals Experience… more
- LA Care Health Plan (Los Angeles, CA)
- …The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse ( RN ) II provides direct assistance to member's with ... Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC...agencies. Good working knowledge of regulatory requirements/standards. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Carle (Urbana, IL)
- …Work Location: Working from Home + Weekend Requirements: no + Other Posting Information: Registered Professional Nurse ( RN ) License Illinois upon hire. + ... clinical documentation review to establish and manage clinical and prior authorization denial appeals for...REQUIREMENTS Bachelor's Degree in Nursing CERTIFICATION & LICENSURE REQUIREMENTS Registered Professional Nurse ( RN ) License… more
- Magellan Health Services (Hodge, LA)
- …State Licensure - Care Mgmt, PT - Physical Therapist, State Licensure - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... care. Oversees utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the...policies and processes. Also oversees the health plans 24/7 Nurse Line program and the clinical management… more
- Stanford Health Care (Palo Alto, CA)
- …**This is a hybrid Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN ) will be responsible for ensuring the ... Stay current with regulatory policies and guidelines related to clinical appeals . + Apply regulatory knowledge to...other healthcare software. **Licenses and Certifications** + Nursing / RN - Registered Nurse -… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …a systems and implementations team. FEP is BCBSMA's single largest account Position Summary: The RN Clinical Provider Post Service Review Manager , led by a ... a member and provider call center, provider correspondence and appeals , clinical review, member correspondence and reconsiderations,...Registered Nurse , is responsible for a team… more
- PeaceHealth (Vancouver, WA)
- …clinical DRG-downgrade denials in the inpatient acute care setting Credentials + Required: Registered Nurse In state of practice or + Required: Certified ... of all areas of adult medicine. (Required) Department / Location Specific Notes Additional Registered Nurse licensure may be required within one year of hire,… more
- CareFirst (Baltimore, MD)
- …Case Management, Utilization Management including prior authorization, and post service clinical medical review and Appeals & Grievances operational functions ... authorization meet all Federal, State and NCQA requirements. + Appeals , Grievances & Clinical Medical Review: Oversees...operating budgets, and large teams. **Preferred Qualifications:** + MBA, RN or MD/DO. + Previous experience at the Vice… more
- Adecco US, Inc. (Phoenix, AZ)
- …Previous EMR experience + Prior experience in classroom and/or on-site training **Requirements:** + Registered Nurse licensure in state of AZ, active and clear + ... Supervisor to join their team! **_** IMPORTANT MUST HAVES: RN license in AZ, CCDS or CDIP certification **_**... validation and works with the denials team for appeals . + Monitor clinical quality measures for… more
- Select Medical (Los Angeles, CA)
- …Century City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) Registered Nurse ( RN ) or Licensed Clinical Social Worker (LCSW) **Pay Rate: $50 - ... to the patient. **Qualifications** **Minimum Qualifications** + Current licensure in a clinical discipline per state guidelines ( RN , LCSW preferred). + Previous… more
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