- 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 responsible for processing the medical necessity of Medicare appeals for participating providers. **Key Responsibilities** + Requesting clinical, research,… 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...Case Manager Upon Hire Preferred + LNCC - Legal Nurse Consultant Certified Upon Hire Preferred **Experience:**… more
- Centene Corporation (Jefferson City, MO)
- …Develop and maintain the audit process and tools related to: authorizations, appeals , quality events, and case management in CCMS; interrater reliability related to ... compliance with the auditing process + Act as a consultant related to system auditing to others in the...+ Complies with all policies and standards POSITION IS REMOTE BUT CANDIDATE MUST RESIDE IN MISSOURI **Ideal candidate… more