- 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 ...**Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse -… more
- RWJBarnabas Health (Oceanport, NJ)
- Clinical Appeals , RN , RemoteReq #:0000173624 Category:Billing/Collections/Registration Status:Full-Time Shift:Day Facility:RWJBarnabas Health Corporate ... Services Department: Appeals Location: Remote , 2 Crescent Place, Oceanport,...is an integral part of our company's success. The RN of Appeals within the RWJ Barnabas… more
- MetroHealth (Cleveland, OH)
- …socioeconomic backgrounds Preferred: Currently licensed or licensed by endorsement as a LPN, Registered Nurse , MD or MD equivalent. Minimum 5 years acute ... departments and more than 20 health centers.** **Summary:** **Performs secondary clinical chart reviews, resolves DRG discrepancies, and educates clinical … more
- LA Care Health Plan (Los Angeles, CA)
- …an enthusiastic team player. Must be able to work independently. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Supervisor, Appeals and Grievances Clinical Operations RN Job Category: ...requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations… more
- LA Care Health Plan (Los Angeles, CA)
- …The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse ( RN ) II provides direct assistance to member's with ... Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC...agencies. Good working knowledge of regulatory requirements/standards. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- VNS Health (Manhattan, NY)
- …Will Do + Responsible for direct oversight and the day to day management of clinical appeals review processes within Appeals & Grievances Department. + ... Health Plans is seeking a dedicated Manager, Grievance and Appeals ( RN )to lead the daily operations of...+ License and current registration to practice as a registered professional nurse in New York State… more
- Elevance Health (Walnut Creek, CA)
- **Manager II Grievance/ Appeals ( RN )-California** **Location** : This position will work a hybrid model ( remote and office). The ideal candidate will live ... contracts, benefits, clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non- clinical and clinical services,… more
- Scripps Health (San Diego, CA)
- …Scripps Health for over 10 years. We invite you to join our Revenue Cycle team as a Registered Nurse of Appeals . * In this role, you will be responsible for ... RN Program. * Three to five years recent clinical experience in a variety of settings. * Knowledge...**Job:** ** RN * **Organization:** **Scripps Health Corp* **Title:** * RN - Appeals - Revenue Cycle -… more
- Elevance Health (Los Angeles, CA)
- ** Nurse Appeals - Licensed RN ...** **Location:** This position will work in a hybrid model ( remote and office). Ideal candidates will live in the state ... locations. **Shift:** Monday to Friday from 8:00am-5:00pm PST The ** Nurse Appeals ** is responsible for investigating and.../grievances/quality of care issues and is a resource for clinical and non clinical team members in… more
- R1 RCM (Boise, ID)
- …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help our ... position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct...at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position,… more
- R1 RCM (Boise, ID)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** +...external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + **Active AHIMA or… more
- State of Colorado (Denver, CO)
- Registered Nurse I-$25,000 SIGN ON BONUS Colorado Mental Health Hospital in Fort Logan-Denver Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4716699) Apply Registered Nurse I-$25,000 SIGN ON BONUS Colorado Mental Health Hospital in Fort… more
- LA Care Health Plan (Los Angeles, CA)
- … Registered Nurses and Medical Directors to appropriately investigate, review and resolve clinical appeals and grievances. Prepares Nurse Summary for MD ... Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical...under the direct supervision and management of the A&G Nurse Specialist, RN and/or Medical Director. This… more
- Providence (Beaverton, OR)
- …Nursing or Health Education + Within six months of hire date: Current unencumbered Registered Nurse License in Washington State + Case Management Experience (EX. ... the best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN who will:** + Support the commercial insurance… more
- Providence (WA)
- …with physicians in the collaboration and management of patient care + Current unencumbered Registered Nurse License in the State of Oregon or Washington or both ... must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN who will:** +...nearing end of life + Care management services includes: nurse education, care coordination and general assistance with managing… more
- Stanford Health Care (Palo Alto, CA)
- …a remote Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN ) will be responsible for ensuring the ... Stay current with regulatory policies and guidelines related to clinical appeals . + Apply regulatory knowledge to...systems and other healthcare software. **Licenses and Certifications** + Nursing/ RN - Registered Nurse -… more
- St. Luke's University Health Network (Allentown, PA)
- …review. Provides billing with information needed to obtain payment of claims. Remote within local geography after orientation. JOB DUTIES AND RESPONSIBILITIES: + ... preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending....an accredited, professional nursing program. + Must have current RN license to practice in the state of Pennsylvania… more
- CareFirst (Baltimore, MD)
- …+ Reviews Clinical Appeals and Grievances documentation written by the clinical appeals nurse and non- clinical supporting team members within ... evaluate clinical quality and procedures within the Clinical Appeals & Grievance Department Government Programs...addition to the required work experience. **Licenses/Certifications:** + Health Services\ RN - Registered Nurse -… more
- AdventHealth (Altamonte Springs, FL)
- …utilizing InterQual and/or MCG . Minimum of three (3) years' experience as Registered Nurse ( RN ) in an acute clinical setting . Clinical experience ... we are even better. **Shift** : Full-time, Monday-Friday **Job Location** : Remote **The role you'll contribute:** This position is responsible for investigating and… more
- State of Colorado (Pueblo, CO)
- Nurse Residency Program ( RN I) -...Rights Minimum Qualifications: Applicants must possess a valid, active Registered Nurse License issued by the State ... CMHHIP - Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4742443) Apply Nurse Residency Program ( RN I) - CMHHIP - Pueblo Salary… more