- R1 RCM (Salt Lake City, UT)
- …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help our ... basic computer skills is essential for excelling in this remote , production-driven position. **Here's what you will experience working...position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct… more
- R1 RCM (Chicago, IL)
- …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
- Trinity Health (Farmington Hills, MI)
- …and determining root causes of clinical denials. Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, ... patient status, length of stay, level of care, missing pre-certification, or other clinical reasons and constructing warranted appeals for defined populations as… more
- CVS Health (Hartford, CT)
- …zone of residence. **Position Summary** Responsible for the review and resolution of clinical appeals . Reviews documentation and interprets data obtained from ... active and unrestricted RN licensure in state of residence + 3+ years clinical experience **Preferred Qualifications** + Appeals Experience + Managed Care… 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
- Banner Health (AZ)
- …Management Services for Banner Plans & Networks, you will co-manage more than 30 remote RNs. Your expertise in nursing and leadership will be crucial for responding ... to process and clinical questions, authorizing the distribution of assignments, managing payroll...off, and addressing issue escalations. The position is fully remote , with work shifts mainly from Monday to Friday… more
- University of Virginia (Charlottesville, VA)
- …and evaluate complex medical documentation + Demonstrates competence in interpretation of clinical data and the application of UM tools Collaborates with physicians ... consultants and internal UVA UR MD's. + Provides complete accurate and timely clinical data to Insurance companies + Utilizes judgement and critical thinking to… more
- Providence (Vancouver, WA)
- …best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN who will:** + Provide care coordination, case management ... nearing end of life + Care management services include: nurse education, care coordination and general assistance with managing...care to our members **Providence Health Plan welcomes 100% remote work for applicants who reside in the following… more
- Sharecare, Inc. (Columbus, OH)
- …or assist member in working with payer to complete prior authorization or appeals process, when necessary. + Abide by Clinical Advocacy Program Description ... for everyone. To learn more, visit www.sharecare.com. **Job Summary:** The Clinical Advocate supports the implementation and delivery of Sharecare's Advocacy program… more
- State of Colorado (Denver, CO)
- …Less than one year of experience 09 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)
- …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 (Denver, CO)
- Charge Nurse RN II - CO Mental Health Hospital in Fort Logan (S. Denver) *$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 Logan (S. Denver) *$14,000… 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 - ... shift offered. We have multiple openings. Specific Job Duties: Clinical Duties: Ensures the provision of patient care is...patient care is within standards established by the State Nurse Practice Act and the Division of Youth Services… more
- Medical Mutual of Ohio (OH)
- …procedures. Manages initial, concurrent, and retrospective review of cases, including appeals , through evaluation of clinical information using established ... **_This is a remote opportunity in Ohio. Note, quarterly on-site requirement...State Nursing Board. . 3 years as a Registered Nurse with a combination of clinical and… more
- LifePoint Health (Brentwood, TN)
- … evidence within the medical record and evidence-based literature. . Ensure appeals follow current industry clinical guidelines, evidence based medical, ... do:* As a *CDI Manager*, you will direct the activities of the Clinical Documentation Integrity (CDI) program for their assigned facilities. The CDI Manager is… more
- Elevance Health (Las Vegas, NV)
- ** Nurse Medical Management I** **Location:** Las Vegas, NV; Denver, CO; Seattle, WA; Walnut Creek, CA; Costa Mesa, CA & Woodland Hills, CA. This position will work a ... hybrid model ( remote and office) and participate in health plan sponsored...may be required to work some weekend shifts. The ** Nurse Medical Management I** will be responsible to collaborate… more
- Magellan Health Services (Honolulu, HI)
- …cost of care. Oversees utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the interaction with claims ... This is a remote /work from home position, but candidates need to...policies and processes. Also oversees the health plans 24/7 Nurse Line program and the clinical management… more
- Elevance Health (Tampa, FL)
- …miles / 1 hour commute of Tampa or Miami, FL offices. This is primarily a remote position but may be required to go in for meetings/training. MUST RESIDE IN THE ... Friday. **2 Holidays** per year and **occasional** weekends. The ** Nurse Medical Management Sr** serves as **team lead** for...of care and accurate claims payment. May also manage appeals for services denied. Primary duties may include, but… more
- Molina Healthcare (Bronx, NY)
- …and MLTC/LTC experience are highly preferred. Additional experience with appeals , quality review, and experience with data collection/reports.** **_Bilingual ... are encouraged to apply._** **Work hours: Monday - Friday 8:30AM- 5:00PM EST** ** Remote position with light travel- 10-15% for in person meeting at the Bronx… more
- Molina Healthcare (Louisville, KY)
- …state, and local laws and regulatory requirements affecting the medical and clinical staff. **Job Duties** + Provides medical oversight and expertise in ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more