- 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
- 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 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
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals ... discharge planning or utilization review experience. **Licenses/Certifications** RN - Registered Nurse - State Licensure And/or Compact State Licensure RN-VA, DC and… 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 ... prior authorization, pre-determination and/or dispute denials via retro authorization, appeals or reconsiderations related to no authorization denials + Perform… 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