- Humana (Annapolis, MD)
- **Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals . The Appeals Nurse ... and independent determination of the appropriate courses of action. The Appeals Nurse 2 reviews documentation and interprets data obtained from clinical records… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and ... collecting, organizing and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety of sources. We are looking… more
- Johns Hopkins University (Baltimore, MD)
- …our ambulatory GI practices located at White Marsh and Bayview. The Nurse Practitioner works collaboratively within a multidisciplinary health team to optimize team ... to patient questions and concerns that a Medical Office Coordinator or nurse cannot answer + Refills urgent prescriptions and/or tracks current prescriptions for… 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 form completions, Social Security ... triage during clinic hours. **Minimum Qualifications** + Individual must be a registered nurse , licensed in the State of Maryland. + Completion of the JHU… more
- Sharecare (Annapolis, MD)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- CVS Health (Annapolis, MD)
- …accordance with contract. + Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) ... incoming correspondence and internal referrals. + Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs… more
- Johns Hopkins University (Baltimore, MD)
- …to patient questions and concerns that a Medical Office Coordinator or nurse cannot answer + Refills urgent prescriptions and/or tracks current prescriptions for ... receiving ongoing care. + Assist with medication prior authorizations and appeals . + Assist Medical Office Coordinators with procedure pre-authorizations as needed.… more