- CareFirst (Baltimore, MD)
- …**PURPOSE:** This position will support the government programs line of business. The Clinical Appeals Nurse completes research, basic analysis, and ... of member and provider disputes regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of… more
- Molina Healthcare (Columbus, OH)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions… 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
- Elevance Health (Walnut Creek, CA)
- ** Nurse Appeals - Licensed RN Nurse...**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
- Centene Corporation (Jefferson City, MO)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by… 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
- US Tech Solutions (Columbia, SC)
- … appeals by both member and provider based on clinical documentation, contractual requirements, governing agencies, policies and procedures, while adhering ... be onsite for training and then moved to work remote . Equipment will be provided. + Prefer 2 yrs....will be provided. + Prefer 2 yrs. UM and/or appeals experience. We want to see all candidates with… more
- Centene Corporation (Austin, TX)
- …role. Candidate must posses a compact nursing license. _** Position Purpose: Performs clinical reviews needed to resolve and process appeals by reviewing medical ... 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,… 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
- 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: + ... + Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending. + Coordinates RAC … more
- Walgreens (Deerfield, IL)
- …and complex, chronic conditions. \#LI-AJ1 **Job ID:** 1524615BR **Title:** Registered Nurse (RN) - Nursing Network ( 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 Miami (Miami, FL)
- …tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . This position is hybrid/ remote The Department of Medicine Division of ... and Metabolism has an exciting opportunity for Two (2) Nurse Navigators to work in South Florida. The ...and assures timely responses within 48 hrs. + Retrieve clinical related messages and return calls within 48 hours.… more
- State of Colorado (Denver, CO)
- …Less than one year of experience 10 How many years of experience do you have as Nurse Manager, or Clinical Supervisor? + 2 or more years of experience + 1-2 ... Youth Corrections Medical Operations Coordinator ( Nurse V) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4573875) Apply Youth Corrections… more
- State of Colorado (Denver, CO)
- Assistant Nurse Manager - Nurse III - Colorado Mental Health Hospital in Fort Logan (S. Denver) Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4826298) Apply Assistant Nurse Manager - Nurse III - Colorado Mental Health Hospital in Fort… more
- State of Colorado (Denver, CO)
- …assuring timely completion of work, providing clinical leadership and teaching clinical interventions + Functions as the Charge Nurse , when assigned, and ... Registered Nurse I-$14,000 SIGN ON BONUS Colorado Mental Health...coordinates and implements medical and psychiatric crisis intervention in clinical emergencies assuring compliance with nursing standards and policies/procedures… 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 (Centennial, CO)
- Registered Nurse I - Marvin Foote Youth Services Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4819409) Apply Registered Nurse I ... of Position: Delivers health care to detained and committed youth within the nurse 's scope of practice. Primary care is provided by independent practitioners with… 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
- Elevance Health (Seattle, WA)
- ** Nurse Medical Mgmt I - Washington** Location: **This position is primarily a Virtual/ Remote role. Ideal candidates** **Must live within 50 miles of the ... am to 4:30 pm (Pacific Standard Time)** . The ** 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
- Defense Health Agency (Edinburgh, IN)
- **Overview** Clinical Psychologist (Camp Atterbury, Edinburgh, IN) Indianapolis, IN Camp Atterbury is located in Edinburgh, Indiana which is just outside, a very ... **Responsibilities** 1. Serves as the Medical Evaluation Board (MEB) Clinical Psychologist subject matter expert and consultant for the development… more