- 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, ... necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support**...would provide an equivalent background. + Current active unrestricted RN license to practice as a health professional within… more
- Molina Healthcare (Dallas, TX)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals ... reviews of previously denied cases in which a formal appeals request has been made or upon request by...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… 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...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- Cognizant (Austin, TX)
- …expectations. **What you need to have to be considered** + Educational background - Registered Nurse ( RN ) + 2-3 years combined clinical and/or utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines… 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 ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- HCA Healthcare (San Antonio, TX)
- …new clinical staff Education: + Successful completion of an accredited Licensed Practical/Vocational Nurse Program + RN licensure is preferred Experience: + A ... an organization that invests in you as a Clinical Nurse Reviewer? At Parallon, you come first. HCA Healthcare...+ A minimum of one-year experience with denials and appeals in a clinical setting preferred + A minimum… more
- Houston Methodist (Sugar Land, TX)
- …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... utilization review activities, and monitoring the clinical denial management and appeals process, as applicable, in collaboration with clinical team partners. This… more
- Texas Health Resources (Arlington, TX)
- …management growth inclusive of supervisory and leadership experience Required Licenses and Certifications RN - Registered Nurse Upon Hire Required Or LMSW ... staff adoption of workplace changes. Directs the activities of the Care Transition Managers ( RN & SW). Serves as a content expert on the following: Compliance with… more
- Texas Health Resources (Frisco, TX)
- …management growth inclusive of supervisory and leadership experience Required Licenses and Certifications RN - Registered Nurse Upon Hire Required Or LMSW ... with outpatient care management. Directs the activities of the Care Transition Managers ( RN & SW). Serves as a content expert on the following: Compliance with… more
- San Antonio Behavioral Health (San Antonio, TX)
- …May consult with staff as needed. Essential Duties: + Collaborate and set standards with registered nurse ( RN ) case managers (CMs) and outcome managers to ... of potential denials and respond appropriately; ie facilitate Physician to Physician appeals when appropriate and assist with construction of appeal letters. +… more