- 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… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider ... appeals that require medical review to determine if the...analyzes professional and institutional claims using critical thinking, nursing clinical judgment and corporate/medical policies for claims processing and/or… more
- Intermountain Health (Annapolis, MD)
- …requests and/or review of denials to ensure medical necessity, payer policies, appeals and reconsideration needs. Promotes the quality and cost effectiveness of ... patient care using clinical acumen in preparation of documentation, audits of patient...prior authorization, pre-determination and/or dispute denials via retro authorization, appeals or reconsiderations related to no authorization denials +… more