- Kepro (Indianapolis, IN)
- …solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Job Summary: Our ... Utilization Management Appeals Nurse - LPN/RN will help orchestrate the seamless resolution of appeals in line with health regulations. He or She will… more
- CareFirst (Owings Mills, 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
- HCA Healthcare (San Antonio, TX)
- …HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Clinical Appeals Nurse RN with Parallon you can be a part of an ... to succeed in our organization. We are looking for an enthusiastic Clinical Appeals Nurse RN to help us reach our goals. Unlock your potential! **Job Summary… more
- R1 RCM (Salt Lake City, UT)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid… more
- CVS Health (Hartford, CT)
- …telework position. Hours for this role are Monday-Friday 8a-5p. Position Summary The Appeals Nurse Consultant position is responsible for processing the medical ... necessity of Medicare Part C appeals from both members and providers. This role is...a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,… more
- Actalent (Dayton, OH)
- Job Title: Clinical Appeals Nurse Salary - (60k - 68k depending on experience) Job Description The Clinical Appeals Nurse is responsible for managing ... role involves reviewing and completing both provider and member clinical appeals within designated timeframes, preparing State Hearing packets, and ensuring… more
- Elevance Health (Knoxville, TN)
- ** Nurse Appeals - Licensed Nurse ** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live in the state of ... or within 50 miles of one of our PulsePoint locations. The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical quality oversite. ... DME, and Complex Care Needs. Essential Qualifications + Current licensed Registered Nurse (RN) with state licensure. Must retain active and unrestricted licensure… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II is primarily responsible for the overall… more
- Baptist Memorial (Memphis, TN)
- Summary Medicare / Medicaid Appeals Registered Nurse reviews and evaluates medical documentation to support billing compliance and external regulatory ... Responsibilities + Abstracts pertinent information from the medical record to create appeals for cases denied by governmental payors. + Educates department staff to… more
- UNC Health Care (Chapel Hill, NC)
- …communities we serve. RN Utilization Manager position specifically for a Utilization Manager/Clinical Appeals Nurse . This person is based at the Hedrick building ... **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North Carolina. **Professional Experience Requirements:**… more
- ManpowerGroup (Durham, NC)
- **Title:** **Clinical Appeals Analyst** **Location: 4613 University Drive Durham NC 27707 United States (Onsite)** **Duration: 6+ months** **Pay rate: $41.75/hr (On ... W2)** **Job Description:** The Clinical Appeals Consultant is responsible for supporting the increased workload...requested. **Hiring Requirements:** + **Licensure:** Must be a Registered Nurse (RN) licensed in the state of North Carolina… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the… more
- Centene Corporation (Sacramento, CA)
- …California. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more
- Trinity Health (Farmington Hills, MI)
- …Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing ... of appeals as required by payers, in addition to promoting...possess a demonstrated knowledge of denial management functions. Registered Nurse and a graduate of an accredited school of… more
- CareFirst (Baltimore, MD)
- …of the Clinical Medical Claims Review, Medical Underwriting, Medical Policy, Clinical Appeals and Analysis programs and Quality of Care Complaint Unit. May lead ... that week. **ESSENTIAL FUNCTIONS:** + Directs the Medical Review and Appeals units and manages multiple strategic clinical projects that span organizational… more
- Penn Medicine (Philadelphia, PA)
- …work? **Summary:** Responsible for coordinating office activities for the Clinical Appeals Coordinators to assist the department in accomplishing the goals and ... also follow expected timelines for Federal and State audits and appeals . **Responsibilities:** + Demonstrates Professionalism within the framework of Relationship… more
- Trinity Health (Farmington Hills, MI)
- …as part of the payment resolution team that receives, analyzes, and appeals denials received for an assigned PBS location. Reviews, researches and resolves ... knowledge of state/federal laws as they relate to contracts and the appeals process. Investigates and addresses overpayment and underpayment accounts with the… more
- Trinity Health (Farmington Hills, MI)
- …knowledge of state/federal laws as they relate to contracts and the appeals process. Assists in training Payment Resolution Specialist I colleagues upon hire ... manner possible: + Coordinates follow-up activities with Utilization Review/Case Management/Coding/ Nurse Liaison to provide required clinical support, as well as… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB...health plan. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California, Active BLS -… more