- Astyra Corporation (New Bern, NC)
- …services:* Process referrals and perform option counseling* Conduct assessments and quality assurance reviews* Provide service plan management and customer service* ... need for daily living activities (ADLs).As a PCS *Home Health Registered Nurse *, you'll play a crucial role in determining needs-based eligibility for… more
- Elevance Health (Walnut Creek, CA)
- ** Nurse Appeals ( Quality ) - California candidates only** **Location: This is a virtual position and prefer candidates reside within 50 miles of an Elevance ... + Utilizes leadership skills and serves as a subject matter expert for appeals /grievances/ quality of care issues and is a resource for clinical and non clinical… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical quality oversite. This ... internal policies/procedures. + Identify case issues, assist in developing quality initiatives and policy development. + Identifies potential Third-Party Liability… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and...achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II… more
- Elevance Health (Columbus, OH)
- ** Nurse Appeals - Licensed RN Nurse...skills and serves as a subject matter expert for appeals /grievances/ quality of care issues and is a resource ... 5:00 pm ET (will work weekends and holidays as needed). The ** Nurse Appeals ** position is responsible for investigating and processing medical necessity … more
- Actalent (Dayton, OH)
- Job Title: Clinical Appeals Nurse Salary - (60k - 68k depending on experience) Job Description The Clinical Appeals Nurse is responsible for managing ... role involves reviewing and completing both provider and member clinical appeals within designated timeframes, preparing State Hearing packets, and ensuring… more
- Centene Corporation (New York, NY)
- …as excellent writing capabilities. **Position Purpose:** Facilitate medical necessity appeals and denials including disposition of denials notification letters, ... claim payment based on company policies and + National Committee for Quality Assurance (NCQA) guidelines, including overturning denied claims, upholding the denials… more
- ManpowerGroup (Durham, NC)
- **Title:** **Clinical Appeals Analyst** **Location: 4613 University Drive Durham NC 27707 United States (Onsite)** **Duration: 6+ months** **Pay rate: $41.75/hr (On ... W2)** **Job Description:** The Clinical Appeals Consultant is responsible for supporting the increased workload in the Claims Department, particularly due to an… more
- LA Care Health Plan (Los Angeles, CA)
- …Required: Knowledge of state, federal and regulatory requirements in Appeals /Care/Case/Utilization Management/ Quality . Strong verbal and written communication ... Supervisor, Appeals and Grievances Clinical Operations RN Job Category:...Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and… more
- Centene Corporation (Sacramento, CA)
- …California. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. + Prepares case reviews for Medical Directors by… more
- CareFirst (Baltimore, MD)
- …direction of the Clinical Medical Claims Review, Medical Underwriting, Medical Policy, Clinical Appeals and Analysis programs and Quality of Care Complaint Unit. ... that week. **ESSENTIAL FUNCTIONS:** + Directs the Medical Review and Appeals units and manages multiple strategic clinical projects that span organizational… more
- Penn Medicine (Philadelphia, PA)
- …of the Clinical Appeals Coordinator in all phases of the Clinical Quality and Utilization Management functions including but not limited to data entry, obtaining ... work? **Summary:** Responsible for coordinating office activities for the Clinical Appeals Coordinators to assist the department in accomplishing the goals and… more
- Henry Ford Health System (Troy, MI)
- …prompt and thorough investigation of medical, transportation, and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): Commercial, Medicare ... RESPONSIBILITIES:\ + Conduct the primary investigation and resolution of member appeals and grievances following established guidelines from: The Center for Medicaid… more
- City and County of San Francisco (San Francisco, CA)
- …driver in one or more quality improvement projects, or roles such as charge nurse , nurse preceptor, nurse educator, nurse practitioner, or other ... of Public Health prioritizes equitable and inclusive access to quality healthcare for its community and values the importance...resulting from this recruitment may be used to fill Nurse Manager (Ambulatory Care) positions for the next six… more
- State of Colorado (Pueblo, CO)
- Unit Nurse Manager-Adolescent Behavioral Treatment Unit CMHHIP - $25,000 SIGN ON INCENTIVE!! Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4544187) Apply Unit Nurse Manager-Adolescent Behavioral Treatment Unit CMHHIP - $25,000 SIGN ON… more
- State of Colorado (Denver, CO)
- Charge Nurse RN II - CO Mental Health Hospital...The vision of CMHHIFL is to provide the highest quality mental health services to person with complex, serious, ... *$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… more
- State of Colorado (Denver, CO)
- Registered Nurse I-$14,000 SIGN ON BONUS Colorado Mental Health Hospital in Fort Logan-Denver Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4473211) Apply Registered Nurse I-$14,000 SIGN ON BONUS Colorado Mental Health Hospital in Fort… more
- State of Colorado (Jefferson County, CO)
- Director of Nursing / Medical Support ( Nurse V) - Wheat Ridge Regional Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4549055) Apply ... Director of Nursing / Medical Support ( Nurse V) - Wheat Ridge Regional Center Salary $108,540.00 - $151,968.00 Annually Location Jefferson County, CO Job Type Full… more
- State of Colorado (Denver, CO)
- Registered Nurse I - Gilliam Youth Services Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4568704) Apply Registered Nurse I - ... patient care is within standards established by the State Nurse Practice Act and the Division of Youth Services...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Pueblo, CO)
- Registered Nurse II - High Acuity - CMHHIP - Pueblo - $25,000 Sign On Incentive Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4542519) Apply ... Registered Nurse II - High Acuity - CMHHIP - Pueblo...in Pueblo (CMHHIP) is a leading employer, provider of quality mental health services, and a community partner. CMHHIP… more
