- A-Line Staffing Solutions (New York, NY)
- …Case Manager, Case Management, InterQual, Medicare, Medicaid, CMS Guidelines, Utilization Review , Utilization Management, Registered Nurse , MCO, RN, Nurse ... Case Manager, Case Management, InterQual, Medicare, Medicaid, CMS Guidelines, Utilization Review , Utilization Management, Registered Nurse , MCO, RN, Nurse… more
- Compass Health Network (Odessa, MO)
- …providers are covered and CCBHO requirements are met Minimal to Frequent schedule changes Nurse will review medication education forms with clients Review ... a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff...our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our… more
- Compass Health Network (Odessa, MO)
- …interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion" ... our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our...ensure our clients are taken care of. An Outpatient Nurse will have a Monday through Friday schedule with… more
- Compass Health Network (Arnold, MO)
- …providers are covered and CCBHO requirements are met Minimal to Frequent schedule changes Nurse will review medication education forms with clients. Review ... a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff...our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our… more
- Compass Health Network (St. Charles, MO)
- …interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion" ... to best serve our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our clients are taken care… more
- Compass Health Network (St. Charles, MO)
- …interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion" ... to best serve our clientele. This role will actively communicate with their Clinical Doctor and Customer Relations Specialist to ensure our clients are taken care… more
- VNS Health (Manhattan, NY)
- …practices, and technology through comprehensive orientation and ongoing education. Oversees clinical peer review , and manages the recruitment, education, ... (LCSW) in New York State or other independent licensure (LMHC, LMFT, clinical psychologist, or psychiatric Nurse Practitioner). requiredLicensure in other states… more
- Accounting Now (Tampa, FL)
- The Denials Specialist performs advanced-level work related to clinical and coding denial management and appeals follow-upThe individual is responsible for ... conducting a comprehensive review of the insurance...processes and escalates timely filing requests to LeadershipCollaborates with Clinical Denials Nurse , Coding Denials Specialists, and… more
- R1 RCM (Salt Lake City, UT)
- …**Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical records and payer denial ... analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you...contractors or commercial payers. Every day you will thoroughly review patient clinical and hospital course documentation,… more
- Molina Healthcare (Georgetown, KY)
- …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...specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service… more
- R1 RCM (Chicago, IL)
- …automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to draft ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and… more
- HCA Healthcare (Nashville, TN)
- …HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Clinical Reviewer with Parallon you can be a part of an organization ... in our organization. We are looking for an enthusiastic Clinical Reviewer to help us reach our...goals. Unlock your potential! **Job Summary and Qualifications** The Clinical Review Specialist is responsible for performing… more
- Apex Health Solutions (Houston, TX)
- …as well as carrying out day today pre-authorization functions. The Utilization Review Nurse will also be responsible for issuing pre-authorization ... as a contact and resource person to Health Solutions' members for the utilization review (UR) of healthcare services. The UM Reviewer will be responsible for… more
- Cleveland Clinic (Cleveland, OH)
- …Management RN Reviewers perform UM activities including admission review , concurrent review , retrospective chart review and clinical systems review ... for the patient's hospital stay or visit. Other responsibilities include medical record review , providing clinical information to the payer, UM data collection… more
- Centene Corporation (Austin, TX)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... a candidate who resides in Texas. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… 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
- Elevance Health (Rancho Cordova, 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 of ... **Shift:** Monday to Friday from 8:00-5:00 pm PT The ** Nurse Appeals ** is responsible for investigating and...medical information for medical director, consultants and other external review . + Prepares recommendations to either uphold or deny… more
- CareFirst (Baltimore, MD)
- …programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Clinical Appeals and Analysis **Equal Employment Opportunity** ... all lines of business. Ensures quality management of the clinical appeal process to reduce the risk of State...with dynamic goals resulting in the full and fair review of appeals and designed to achieve… more
- Elevance Health (Los Angeles, CA)
- ** Nurse Appeals (Quality) - California candidates only** **Location: This is a virtual position and prefer candidates reside within 50 miles of an Elevance ... and summarizes medical information for medical director, consultants and other external review . + Prepares recommendations to assign appropriate level or forwards to… more
- CVS Health (Hartford, CT)
- …Monday-Friday 8a-5p in time zone of residence. **Position Summary** Responsible for the review and resolution of clinical appeals . Reviews documentation and ... active and unrestricted RN licensure in state of residence + 3+ years clinical experience **Preferred Qualifications** + Appeals Experience + Managed Care… more
