- Cognizant (Columbus, OH)
- …cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . ... Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...stand out** . Epic experience . Experience in drafting appeals disputing inpatient clinical validations audits is… more
- CVS Health (OH)
- …support cost-effective quality care for members. Administers review and resolution of clinical complaints and appeals . Interprets data obtained from clinical ... regulatory and accreditation requirements for members and providers. Coordinates clinical resolutions with internal and external support areas. **Required… more
- Molina Healthcare (Akron, OH)
- …resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical ... that has a current active unrestricted license This a remote role and can sit anywhere within the United...set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing… more