- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …retrospective claim review, special review requests, and UM pre\-certifications and appeals , utilizing medical appropriateness criteria, clinical judgement, and ... Health and Withdrawal Management\. + Present cases confidently and effectively during clinical rounds\. + Work independently with minimal supervision\. + Excel in a… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes ... regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all applicable State and Federal… more
- University of Washington (Seattle, WA)
- …**WORK SCHEDULE** + 100% FTE + 100% Remote + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ensures that payers are prepared to ... Financial Services Department** has an outstanding opportunity for a ** Clinical Appeals and Disputes Nurse .**...communicated payer decisions in a timely manner + Review clinical denials and initiate appeals process +… more
- CVS Health (Columbus, OH)
- …each and every day. **Position Summary** CVS Aetna is seeking a dedicated ** Appeals Nurse Consultant** to join our remote team. In this role, you will be ... computer. + Responsible for the review and resolution of clinical appeals . + Reviews documentation and interprets...PM (local time). + No weekends or holidays required. ** Remote Work Expectations** + This is a 100% … more
- Nuvance Health (Danbury, CT)
- *Description* *FULL TIME DAY SHIFTS- VARIABLE HOURS / WEEKEND ROTATIONS REQUIRED* * *Hybrid/ Remote * * *Summary:* The purpose of the Denial Prevention Nurse is to ... in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- LA Care Health Plan (Los Angeles, CA)
- …in Nursing for Registered Nurses Experience Required: At least 8 years of clinical appeals and grievances experience in a managed care, utilization management ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017… more
- Northwell Health (Melville, NY)
- …+ Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect ... retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness… more
- State of Colorado (Pueblo, CO)
- NURSE III - Clinical Specialist - Pueblo...if your application is eliminated. You will find the appeals process, the official appeal form, and how to deliver ... Regional Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5186234) Apply NURSE III - Clinical Specialist - Pueblo Regional Center… more
- Molina Healthcare (Rio Rancho, NM)
- …a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/ appeals . + Provides training and support to clinical peers. + ... JOB DESCRIPTION **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal… more
- Baystate Health (Springfield, MA)
- …Minimum - Midpoint - Maximum $87,859.00 - $100,984.00 - $119,412.00 **UM Outpatient Clinical Review Nurse - Baystate Health, Health New England** **This is a ... **Current States Eligible MA and CT** The **UM Outpatient Clinical Review Nurse ** contributes to the overall...management on referral of members, as appropriate + Performs clinical reviews for member and provider appeals … more
- UPMC (Pittsburgh, PA)
- …for Clinical Auditor/Analysts. + Provide new-hire training to Clinical Auditor/Analysts. Performing administrative appeals /preparing medical necessity ... UPMC Health Plan has an exciting opportunity for a Clinical Auditor/Analyst Intermediate! The Clinical Auditor/Analyst Intermediate is an integral part of the… more
- Magellan Health Services (Albuquerque, NM)
- …cost of care. Oversees utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the interaction with claims ... policies and processes. Also oversees the health plans 24/7 Nurse Line program and the clinical management...and written communications skills. General Job Information Title Director, Clinical Care Services - New Mexico, Remote … 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) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5185912) Apply Charge ... Nurse RN II - CO Mental Health Hospital in...coordinates and implements medical and psychiatric crisis intervention in clinical emergencies assuring compliance with nursing standards and policies/procedures.… more
- State of Colorado (Pueblo, CO)
- Nurse I - Registered Nurse I...This position is responsible for assisting nursing staff with clinical direction of nursing staff, QA/PI activities and to ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5187654) Apply Nurse I - Registered Nurse I - CMHHIP Salary $43.80 - $61.31 Hourly Location… more
- State of Colorado (Pueblo, CO)
- Registered Nurse II- CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5187078) Apply Registered Nurse II- CMHHIP Salary $45.99 - ... and time listed. + Description + Benefits + Questions Department Information Registered Nurse II-Full Time CMHHIP This posting will be used to fill multiple… more
- Garnet Health (Middletown, NY)
- …rural life, we invite to make your career home with us as a CLinical Documnetaion Specialist on our CDI team at/in Garnet Health Medical Center. Responsibilities ... Under the direction of The Administrator, Coding & Clinical Documentation Improvement and Patient Access, the Manager of...day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate… more
- State of Colorado (Pueblo, CO)
- LICENSED PRACTICAL NURSE III - CMHHIP - Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5184282) Apply LICENSED PRACTICAL NURSE III ... Description + Benefits + Questions Department Information Licensed Practical Nurse III - Full Time CMHHIP This position will...and utilizes this person as a resource when necessary. Clinical Skills: + This position ensures that the client's… more
- State of Colorado (Garfield County, CO)
- NURSE II - Veteran's Community Living Center at Rifle Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5195145) Apply NURSE II - Veteran's ... Duty Description: Performs both admission and daily assessments during clinical stay, identifying critical incidents, emergencies, acute illnesses, and behavior… more
- State of Colorado (Garfield County, CO)
- NURSE I - Veterans Community Living Center at Rifle Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5195143) Apply NURSE I - Veterans ... requirements. + Performs both admission and daily assessments during clinical stay, identifying critical stay, identifying critical incidents, emergencies, acute… more
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