- Molina Healthcare (Rio Rancho, NM)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals ... regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and… more
- Evolent (Santa Fe, NM)
- …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators… more
- Cognizant (Santa Fe, NM)
- …, and retro-authorization as well as timely filing deadlines and processes. + Review clinical denials including but not limited to referral, preauthorization, ... cycle or clinic operations + Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews +… more
- Molina Healthcare (Roswell, NM)
- …(Team will work on set schedule) Looking for a RN with experience with appeals , claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...for clinical member services review assessment processes. Responsible… more
- Molina Healthcare (NM)
- …the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the ... medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse… more