- Molina Healthcare (Lincoln, NE)
- …will work on set schedule) Looking for a RN with experience with appeals , claims review , and medical coding. **Job Summary** Utilizing clinical knowledge ... and experience, responsible for review of documentation to ensure medical necessity...state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- Molina Healthcare (Omaha, NE)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of previously ... + Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training,… more
- Intermountain Health (Lincoln, NE)
- …on clinical Appeals and Audits for Intermountain Health. The Audit/ Appeals RN Consultant will execute clinical audits of medical records on behalf of ... **Job Description:** The RCO Audit & Appeals RN Consultant is responsible for...stakeholders throughout the denial process up to and including medical review boards and in the court… more
- Prime Therapeutics (Lincoln, NE)
- …Patient Programs. **Minimum Qualifications** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings and consults with...for work visa or residency sponsorship **Additional Qualifications** + Registered Nurse ( RN ). + 5… more
- Public Consulting Group (Lincoln, NE)
- …decision-making skills, with accuracy and attention to detail. **Qualifications** + Licensed registered nurse ( RN ), a licensed social worker (LSW, ... complaints and routine reviews including an analysis of all relevant medical , training, credentialing and billing records. When necessary, conduct interviews with… more