- Actalent (Dayton, OH)
- Job Title: Clinical Appeals Nurse Salary - (60k - 68k depending on experience) Job Description The Clinical Appeals Nurse is responsible for ... states. This role involves reviewing and completing both provider and member clinical appeals within designated timeframes, preparing State Hearing packets, and… more
- Northwell Health (Melville, NY)
- …stay. Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately ... **Req Number** 130666 Remote Schedule: Mon-Fri/8:00AM - 4:00PM Job Description Reviews and responds to Corporate Compliance Audits and serves as a resource for the… 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 ... a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,...in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates… more
- Trinity Health (Farmington Hills, MI)
- …and determining root causes of clinical denials. Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, ... patient status, length of stay, level of care, missing pre-certification, or other clinical reasons and constructing warranted appeals for defined populations as… 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 ... 50 miles of one of our PulsePoint locations. The ** Nurse Appeals ** is responsible for investigating and...investigations and reviews of member and provider medical necessity appeals . + Investigates member grievances with a clinical… more
- Centene Corporation (New York, NY)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... as excellent writing capabilities. **Position Purpose:** Facilitate medical necessity appeals and denials including disposition of denials notification letters,… more
- Centene Corporation (Sacramento, CA)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... from their home anywhere within the state of California. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing… more
- Trinity Health (Farmington Hills, MI)
- …manner possible: + Coordinates follow-up activities with Utilization Review/Case Management/Coding/ Nurse Liaison to provide required clinical support, as ... Full time **Shift:** Day Shift **Description:** **POSITION PURPOSE** Work Remote Position (Pay Range: $18.4663-$27.6994) Performs day-to- day payment resolution… more
- Trinity Health (Farmington Hills, MI)
- …manner possible: + Coordinates follow-up activities with Utilization Review/Case Management/Coding/ Nurse Liaison to provide required clinical support, as ... Full time **Shift:** Day Shift **Description:** **POSITION PURPOSE** Work Remote Position (Pay Range: $20.6822-$31.0233) Performs day-to- day payment resolution… more
- Walgreens (Deerfield, IL)
- …Opportunity Employer, including disability/veterans". **Job ID:** 1405241BR **Title:** Registered Nurse (RN) Specialty - Remote **Company Indicator:** Walgreens ... specific care modules or standard operation procedures approved by the Clinical and Professional Services Team including scripting, assessments, screenings, and… more
- University of Virginia (Charlottesville, VA)
- …and evaluate complex medical documentation + Demonstrates competence in interpretation of clinical data and the application of UM tools Collaborates with physicians ... consultants and internal UVA UR MD's. + Provides complete accurate and timely clinical data to Insurance companies + Utilizes judgement and critical thinking to… more
- Providence (WA)
- …best people, we must empower them._** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide care ... nearing end of life + Care management services include: nurse education, care coordination and general assistance with managing...+ This posting is for multiple openings of a Clinical Program Coordinator RN, Medicare / Medicaid + Work… more
- Integra Partners (Troy, MI)
- …of UM authorization reviews, both verbally and in writing + Process administrative and clinical appeals and refer as needed to the Medical Director + Maintain ... care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key role in collaborating… more
- State of Colorado (Denver, CO)
- …assigning responsibilities. During specific shifts, functions in the role of Charge Nurse and provides clinical and administrative supervision of nursing staff ... of work, providing clinical leadership and teaching clinical interventions. Functions as the Charge Nurse ,...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Denver, CO)
- Charge Nurse RN II - CO Mental Health Hospital in Fort Logan (S. Denver) *$14,000 Sign On Bonus* Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4556884) Apply Charge Nurse RN II - CO Mental Health Hospital in Fort Logan (S. Denver) *$14,000… more
- LifePoint Health (Brentwood, TN)
- …This role will serve as a navigator for the process flow and denial appeals of complex clinical coding cases. *Responsibilities:* * Responsible for conducting ... degree in health-related field required.** *Required Experience:*2 years of experience preparing appeals for DRG downgrades or writing clinical denials on behalf… more
- State of Colorado (Pueblo, CO)
- Unit Nurse Manager-Adolescent Behavioral Treatment Unit CMHHIP - $14,000 SIGN ON INCENTIVE!! Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4544187) Apply Unit Nurse Manager-Adolescent Behavioral Treatment Unit CMHHIP - $14,000 SIGN ON… more
- State of Colorado (Denver, CO)
- Registered Nurse I - Marvin Foot Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4428385) Apply Registered Nurse I - Marvin Foot Salary ... shift offered. We have multiple openings. Specific Job Duties: Clinical Duties: Ensures the provision of patient care is...patient care is within standards established by the State Nurse Practice Act and the Division of Youth Services… more
- State of Colorado (Pueblo, CO)
- Registered Nurse II - High Acuity - CMHHIP -...more FTE's on a continuous basis as well as clinical supervision of all nursing staff during a specific ... $14,000 Sign On Incentive Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4542519) Apply Registered Nurse II - High Acuity - CMHHIP - Pueblo -… more
- Medical Mutual of Ohio (OH)
- …in Nursing preferred.** **Master's degree in related field a plus.** + **3 years clinical experience as a Registered Nurse , preferably in a health plan.** + ... of Science in Nursing preferred.Master's degree in related field a plus. + 5 years clinical experience as a Registered Nurse , including 1 year in a clinical… more