- Highland Hospital (Rochester, NY)
- …via telemedicine dependent on clinical availability, personal preference, and insurance guidelines for telemedicine coverage 10-20%Office Practice (Non-Face to Face ... + Complete clinical documentation, forms/paperwork requested by patients, prior authorization appeals , sign home care orders + Coordinate with other providers, home… more
- Elevance Health (Indianapolis, IN)
- ** Nurse Appeals ** **Location: Indiana** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... for employment, unless an accommodation is granted as required by law. The ** Nurse Appeals ** is responsible for investigating and processing and medical… more
- Evolent (Springfield, IL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Elevance Health (Indianapolis, IN)
- ** Nurse Appeals RN-Quality of Care** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, ... for employment, unless an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and processing and medical… more
- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and electronic ... format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible to develop a… more
- BJC HealthCare (St. Louis, MO)
- …experience) **Additional Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist with infusion appeals for both government ... be handling clinical denials and sending them to a nurse to review and appeal and then they will...clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be able to multi-task and maintain… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and grievance correspondence, and ... collecting, organizing and tracking information to facilitate and expedite processing of appeals and grievances received from a variety of sources. We are looking… more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with the development of a… more
- CareFirst (Baltimore, MD)
- …& Qualifications** **PURPOSE:** We are looking for a Director, Medical Review & Appeals for our Government Programs lines of business. The incumbent will ensure ... through direction and oversight of the Clinical Medical Claims Reviews, Clinical Appeals and Analysis programs and Quality of Care complaints in conjunction with… more
- St. Luke's University Health Network (Allentown, PA)
- …a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... APR-DRG for the purpose of appealing proposed DRG and coding changes by insurance providers or their respective auditors JOB DUTIES AND RESPONSIBILITIES: + Conduct… more
- State of Indiana (Indianapolis, IN)
- Appeals & Eligibility Specialist Date Posted: Jan 9,...requirements at 42 CFR 483.430, or - A registered nurse in Good Standing with the State of Indiana ... holidays, 14 on election years + Education Reimbursement Program + Group life insurance + Referral Bonus program + Employee assistance program that allows for… more
- Gentiva (Mooresville, NC)
- …Compliance. Streamlining Authorizations. Supporting Patient Care.** The Clinical Authorization Nurse plays a key role in supporting our authorizations department ... compliance and smooth claims processing. **As a Clinical Authorization Nurse , You Will:** + Perform reviews of medical records...+ Manage and communicate with the team regarding the appeals process for claims + Collaborate with Directors of… more
- State of Colorado (Denver, CO)
- Registered Nurse I-Colorado Mental Health Hospital in Fort Logan-Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5197088) Apply ... Registered Nurse I-Colorado Mental Health Hospital in Fort Logan-Denver Salary...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)
- NURSE III - Clinical Specialist - Pueblo Regional...if your application is eliminated. You will find the appeals process, the official appeal form, and how to ... Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5186234) Apply NURSE III - Clinical Specialist - Pueblo Regional Center Salary… 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...if your application is eliminated. You will find 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...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)
- Nurse I - Registered Nurse I -...if your application is eliminated. You will find the appeals process, the official appeal form, and how to deliver ... (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 - ... + Description + Benefits + Questions Department Information Registered Nurse II-Full Time CMHHIP This posting will be used...if your application is eliminated. You will find the appeals process, the official appeal form, and how to… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5123731) Apply CDOC Registered Nurse ( Nurse I) ... Monthly Location Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 10/2025 Department Department of Corrections Division Clinical and Correctional… more
- State of Colorado (Canon City, CO)
- DOC Nurse Supervisor - Canon City Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5180320) Apply DOC Nurse Supervisor - Canon City Salary ... Canon City, CO Job Type Full Time Job Number Nurse III 6253 FCF 12/2025 Department Department of Corrections...Short and long term disability coverage; + Paid life insurance ; + 11 paid holidays per year plus vacation… more
