- Molina Healthcare (San Antonio, TX)
- 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
- Elevance Health (Houston, TX)
- ** Nurse Appeals - Litigation & Legal Support** **In Office Expectation:** This role is **Virtual** ; This role enables associates to work virtually full-time, ... will be necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support** is responsible for investigating and processing… more
- Evolent (Austin, TX)
- …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
- Texas Health Resources (Arlington, TX)
- …treatment team. Maintain ongoing contact with the attending physician, program manager, nurse manager, and various members of the treatment team. Provides timely ... and provides suggestions for improvement Utilizes resources cost effectively Denials and Appeals Reviews denial work queues and denial documentation activities on a… more
- Elevance Health (Houston, TX)
- …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 (TX)
- …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 (TX)
- 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
- Texas Health Resources (Arlington, TX)
- …financial data (eg, LOS data, avoidable days, adverse determinations, and denials/ appeals ) and makes recommendations to improve performance. Achieves and maintains ... of supervisory and leadership experience Required Licenses and Certifications RN - Registered Nurse Upon Hire Required Or LMSW - Licensed Master Social Worker Upon… more
- San Antonio Behavioral Health (San Antonio, TX)
- …staff as needed. Essential Duties: + Collaborate and set standards with registered nurse (RN) case managers (CMs) and outcome managers to ensure that all ... of potential denials and respond appropriately; ie facilitate Physician to Physician appeals when appropriate and assist with construction of appeal letters. +… more