- CareFirst BlueCross BlueShield (Baltimore, MD)
- …authorization of services and approved claims. Oversees retrospective reviews, case appeals , billing coordination, and clinical support. Ensure that staff is fully ... trained and competent on standards of practice of Utilization Management, reimbursement methodologies and treatment coding. Directs the strategic and the day-to-day… more
- CareFirst (Baltimore, MD)
- …for authorization of services and approved claims.Oversees retrospective reviews, case appeals , billing coordination, and clinical support.Ensure that staff is fully ... trained and competent on standards of practice of Utilization Management, reimbursement methodologies and treatment coding.Directs the strategic and the day-to-day… more
- VNS Health (Manhattan, NY)
- …spending accounts (FSAs) for healthcare and dependent care Generous tuition reimbursement for qualifying degrees Opportunities for professional growth and career ... advancement Internal mobility, generous tuition reimbursement , CEU credits, and advancement opportunities Interdisciplinary network of colleagues through the VNS… more
- Genesis Healthcare (Philadelphia, PA)
- …a comprehensive analytical review of patient's medical records. Appeal Writer/ Reimbursement Analyst will write sound, sensible and factual arguments that clearly ... guidance for appeal requests at all levels.Maintains tracking records of appeals management activities in accordance with department policiesPerforms other duties as… 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, CA, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered...benefits including + Paid Time Off (PTO) + Tuition Reimbursement + Retirement Plans + Medical, Dental and Vision… more
- St. Mary's Healthcare (Amsterdam, NY)
- …and audit requests and coordinates attempts to overturn denials by drafting appeals , negotiating with payers, or following up with payer utilization review ... * Collaborates with managed care department to code billable items for reimbursement . Collaborates with appropriate staff to secure information for billable items. *… more
- VNS Health (Manhattan, NY)
- OverviewManages the day to day activities for staff handling of grievances and appeals for one of the following VNS Health Plans product lines - Managed Long Term ... and audits subcontractors who have delegated responsibility for managing grievance and appeals on behalf of the plan to ensure operational and regulatory compliance.… more
- Centene Corporation (Austin, TX)
- …Texas. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more
- Carle (Urbana, IL)
- Outpatient Denial/ Appeals Specialist- RN + Department: Revenue Cycle - CFH_10_19 + Entity: Champaign-Urbana Service Area + Job Category: Clerical/Admin + Employment ... The Fields + Weekend Requirements: no + Other Posting Information: Registered Professional Nurse (RN) License Illinois upon hire. + Holiday Requirements: no Email a… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and grievance ... of cases; review, research and coordination of complaints, grievances, appeals and reconsiderations consistent with statutory and federal regulatory guidelines.… 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 ... + Conduct the primary investigation and resolution of member appeals and grievances following established guidelines from: The Center...two (2) years of experience as a Licensed Practical Nurse (LPN) in the State of Michigan preferred. +… more
- State of Colorado (CO)
- CDOC Nurse Supervisor Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4383689) Apply CDOC Nurse Supervisor Salary $8,204.00 - $11,487.00 ... Monthly Location Statewide, CO Job Type Full Time Job Number CAA Nurse III 2/2024 Department Department of Corrections Division Clinical and Correctional Services… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4555045) Apply CDOC Registered Nurse ( Nurse I) ... Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 7/2024 Department Department of Corrections Division...and sick time; + Employee wellness programs; + Tuition Reimbursement ; + Training opportunities and more. Who May Apply:… more
- State of Colorado (Sterling, CO)
- CDOC Licensed Practical Nurse -- Sterling Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4600127) Apply CDOC Licensed Practical Nurse -- ... holidays per year plus vacation and sick time; + Wellness program,tuition reimbursement , training opportunities and more. This classification (if working within a… more
- Sacramento County (Sacramento, CA)
- Supervising Registered Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448883) Apply Supervising Registered Nurse D/CF Salary ... 5:00 pm on: 2/5/24, 4/2/24, 6/3/24, 8/5/24, 10/7/24, 12/2/24 Supervising Registered Nurse - Detention/Correctional Facility is the first level supervisory class in… more
- Sacramento County (Sacramento, CA)
- Registered Nurse D/CF (Level I/II) Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/454059) Apply Registered Nurse D/CF (Level I/II) ... at 5:00 pm on: 11/6/2023, 1/2/2024, 3/5/2024, 5/7/2024, 7/2/2024, 9/3/2024, 11/5/2024 Registered Nurse D/CF Level I: $61.27 - $74.48 hourly Registered Nurse D/CF… more
- Sacramento County (Sacramento, CA)
- Nurse Practitioner Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/1780920) Apply Nurse Practitioner Salary $127,576.80 - $155,096.64 ... are at 5:00 pm on: 5/10/24, 6/7/24, 7/5/24, 8/2/24, 8/30/24, 9/27/24 Nurse Practitioners provide a range of health care services involving diagnosis, assessment,… more
- Sacramento County (Sacramento, CA)
- Supervising Public Health Nurse Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/600083) Apply Supervising Public Health Nurse Salary ... One year of experience as a Senior Public Health Nurse in Sacramento County service. Or: Two years of...with or cause severe hardship upon department operations. TUITION REIMBURSEMENT : Dependent upon union agreements, regular County employees may… more
- Sacramento County (Sacramento, CA)
- Licensed Vocational Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448956) Apply Licensed Vocational Nurse D/CF Salary ... on: 4/4/24, 7/5/24, 10/3/24 In a detention/correctional facility, the Licensed Vocational Nurse D/CF performs a wide variety of vocational nursing duties, including… more
- Sacramento County (Sacramento, CA)
- Registered Nurse Level I/II Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/2579173) Apply Registered Nurse Level I/II Salary $45.21 - ... 4/9/24, 7/9/24, 10/8/24 . Note: Vacancies may be permanent or intermittent on-call. Registered Nurse Level I: $45.21 - $54.95 hourly Registered Nurse Level II:… more
