- Molina Healthcare (Columbus, OH)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... every 4 weeks Monday-Thursday and Wed - Saturday._** **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct … more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …is eligible for the eWorker persona.The TeamAs an integral part of the Clinical Appeals team, the Appeals Nurse Reviewer will serve as a liaison and ... healthcare? Bring your true colors to blue. The RoleThe Appeals Nurse Reviewer is responsible for reviewing...Payment Policy teams. Key Responsibilities: + Review provider claim appeals utilizing sound clinical judgement, medical policy,… more
- R1 RCM (Detroit, MI)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help ... basic computer skills is essential for excelling in this remote production-drive position. **Here's what you will experience working...position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** +… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II… 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, ... the safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing… 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 our grievance...and committee decisions. * Work Flexibly: Enjoy a mostly remote work environment with just one day a month… more
- Molina Healthcare (Long Beach, CA)
- …contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The **Delegation Oversight Nurse ** is responsible for ensuring that Molina Healthcare's UM ... as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the… 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 (Garfield County, CO)
- NURSE I - Veterans Community Living Center at Rifle Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4596826) Apply NURSE I - Veterans ... requirements. + Performs both admission and daily assessments during clinical stay, identifying critical stay, identifying critical incidents, emergencies, acute… more
- State of Colorado (Golden, CO)
- Registered Nurse I, RN I - Campus at Lookout Mountain, Youth Services Center - Golden Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4874223) ... Apply Registered Nurse I, RN I - Campus at Lookout Mountain,...including physical, psychiatric and dental maintenance. Specific Job Duties: Clinical Duties: Initial nursing assessments and triage of requests… more
- PeaceHealth (Vancouver, WA)
- …and change agent with in-depth knowledge of workflow related to denials and appeals management. Performs in depth reviews of clinical DRG downgrade denials ... implement, and maintain written policies, procedures, and processes related to clinical denial/ appeals . This includes formatted templated design for diagnosis… more
- AdventHealth (Altamonte Springs, FL)
- …years utilizing InterQual and/or MCG . Minimum of three (3) years' experience as Registered Nurse (RN) in an acute clinical setting . Clinical experience of ... we are even better. **Shift** : Full-time; Monday-Friday **Job Location** : Remote **The role you will contribute:** This position is responsible for investigating… more
- Community Health Systems (Sarasota, FL)
- (Full-Time, Remote ) The Clinical Review Analyst is a professionally licensed nurse /LPN who is responsible for effectively managing the denial/appeal process ... without jeopardizing timely filing + Demonstrates excellent technical and clinical skills by drafting credible, defensible appeals ...accounts by following HIPAA guidelines + **This is a remote position.** We know it's not just about finding… more
- MD Anderson Cancer Center (Houston, TX)
- …employees and the public. The primary purpose of the Utilization Review Nurse position is to: Evaluate the necessity, appropriateness, and efficient use of ... of services that includes review of the appropriate patient class, providing clinical reviews to payers utilizing specified guidelines, and facilitate timely peer to… more
- CaroMont Health (Gastonia, NC)
- …for promoting and monitoring safe, high-quality, cost-effective healthcare with the best clinical outcomes possible. Provide physician and nurse education to ... role between CDS workflow and DRG Denial Management and Appeals based on departmental needs. The Clinical ...denials. This position is for CaroMont Health care system. Remote work may be approved per Manager/Director discretion with… more
- US Tech Solutions (Columbia, SC)
- …and appeals . Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. ... Date Provided. + Onsite 1-2 Weeks, then will work remote will provide the equipment will be required to...be a local candidate typical day will be reviewing clinical for pre-certifications for durable medical equipment, home health… more
- Elevance Health (Seattle, WA)
- **Behavioral Health Nurse Medical Mgmt I - Washington** Location: **This position is primarily a Virtual/ Remote role. Ideal candidates** **Must live within 50 ... 4:30 pm (Pacific Standard Time)** . The **Behavioral Health** ** Nurse Medical Mgmt I** is responsible to collaborate with...of care and accurate claims payment. May also manage appeals for services denied. **How you will make an… more
- Sanford Health (SD)
- …clinical or business processes. Responsible for reviewing medical records and preparing clinical appeals , as appropriate, on medical necessity, level of care, ... Registered Nurse (RN) preferred. Five years' experience in a clinical setting required, hospital experience preferred. Preference given to individuals with… more
- Sharecare (Columbus, OH)
- …available 3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and ... The role of the Family Health Advocate Lead is an exciting and innovative remote role newly created to provide meaningful support to both Family Health Advocates who… more
- Sharecare (Columbus, OH)
- …available 3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and ... CST) The role of the Family Health Advocate is an exciting and innovative remote role newly created to provide meaningful support to members and their families… more