- Evolent (Annapolis, MD)
- …Join a mission with a company behind it. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact ... as part of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to… 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
- 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 directs and coordinates the accurate implementation of the clinical appeal process for members ... serves as a resource for associates within the Clinical Appeals and Analysis unit. We are looking for an...3 years supervisory experience. **Licenses/Certifications** + RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon… 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
- Johns Hopkins University (Baltimore, MD)
- …of care. This may include letters of medical necessity for accommodations, appeals for access to treatment, Family Medical Leave Act form completions, Social ... + Basic computer skills. **Minimum Qualifications** + Individual must be a registered nurse , licensed in the State of Maryland or state where practicing. +… more
- Elevance Health (Washington, DC)
- The Utilization Management Nurse is responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, ... in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied. Primary duties may include, but are not limited to:… more
- Ascension Health (Baltimore, MD)
- …related to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals . + Assess and coordinate discharge planning needs with ... and regulations. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Maryland Board of Nursing obtained prior to… more
- CareFirst (Baltimore, MD)
- …authorization of services and approved claims. + Oversees retrospective reviews, case appeals , billing coordination, and clinical support. + Ensure that staff is ... the required work experience. **Licenses/Certifications:** + Health Services\RN - Registered Nurse - State Licensure and/or Compact State Licensure Upon Hire… more
- Trinity Health (Silver Spring, MD)
- …for premium compensation and maximum flexibility? Explore FirstChoice - Trinity Health's nurse staffing solution! FirstChoice RNs are utilized to fill short and ... and Family Centered Care Quality Improvement Organization for patient discharge appeals in accordance with Medicare Conditions of Participation and within… more