- Molina Healthcare (Dallas, TX)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests ... reviews of previously denied cases in which a formal appeals request has been made or upon request by...equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Elevance Health (Houston, TX)
- ** Nurse Appeals - Litigation & Legal Support** **In Office Expectation:** This role is **Virtual** ; This role enables associates to work virtually full-time, ... will be necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support** is responsible for investigating and processing… more
- Evolent (Austin, TX)
- …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
- Cognizant (Austin, TX)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... + Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- HCA Healthcare (San Antonio, TX)
- …Do you want to join an organization that invests in you as a Clinical Nurse Reviewer? At Parallon, you come first. HCA Healthcare has committed up to $300 million ... a difference. We are looking for a dedicated Clinical Nurse Reviewer like you to be a part of...+ A minimum of one-year experience with denials and appeals in a clinical setting preferred + A minimum… more
- Houston Methodist (Sugar Land, TX)
- …utilization review activities, and monitoring the clinical denial management and appeals process, as applicable, in collaboration with clinical team partners. This ... and determines the need for or feasibility of submitting appeals . + Facilitates communication with payors and external case...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
- Texas Health Resources (Arlington, TX)
- …treatment team. Maintain ongoing contact with the attending physician, program manager, nurse manager, and various members of the treatment team. Provides timely ... and provides suggestions for improvement Utilizes resources cost effectively Denials and Appeals Reviews denial work queues and denial documentation activities on a… more
- Elevance Health (Houston, TX)
- …will make an impact:** + Perform physician-level case review, following initial nurse review, of Medical Oncology regimens and supportive care. + Perform ... physician-level case review, following initial nurse review, of chemotherapy regimens. + Determine medical necessity...a subject matter expert. + Perform first level provider appeals as designated by the client for adverse determinations.… more
- Molina Healthcare (TX)
- …medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse ... and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends… more
- Molina Healthcare (TX)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of high ... set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. JOB DESCRIPTION Job...equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more