- Molina Healthcare (Atlanta, GA)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests ... reviews of previously denied cases in which a formal appeals request has been made or upon request by...equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Evolent (Atlanta, GA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals 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 Evolent and… more
- Actalent (Atlanta, GA)
- …the Role We are seeking a detail-oriented and compassionate Utilization Review Registered Nurse (RN) to join our team. In this role, you will ensure appropriate ... coordinators, case managers, providers, members, and internal teams (claims, benefits, appeals , risk management). Required Qualifications + Active RN license in… more
- Elevance Health (Atlanta, GA)
- …will make an impact:** + Perform physician-level case review, following initial nurse review, of Medical Oncology regimens and supportive care. + Perform ... physician-level case review, following initial nurse review, of chemotherapy regimens. + Determine medical necessity...a subject matter expert. + Perform first level provider appeals as designated by the client for adverse determinations.… more
- Molina Healthcare (Atlanta, GA)
- …medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse ... and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends… more
- Molina Healthcare (Atlanta, GA)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of high ... set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. JOB DESCRIPTION Job...equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more