- Cognizant (Lansing, MI)
- …to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and… more
- University of Michigan (Ann Arbor, MI)
- Clinical Denials Prevention & Appeals Specialist...a RHIT or RHIA and or certification as an RN , or a Bachelor's degree and certification in Nursing ... **Job Summary** The Clinical Denials Prevention & Appeals Specialist role is entirely remote. The Clinical... Appeals Specialist role is entirely remote. The Clinical Denials Prevention & Appeals Specialist plays… more
- McLaren Health Care (Grand Blanc, MI)
- …related duties as required and directed. **Qualifications:** _Required_ + State licensure as a registered nurse ( RN ) + Bachelor's degree in nursing from ... and commercial insurance. 8. Educates health team colleagues about complex clinical appeals , utilization review, including role, responsibilities tools, and… more
- Evolent (Lansing, MI)
- …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...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- Corewell Health (Royal Oak, MI)
- …experience in care management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan License Upon ... criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization… more
- Corewell Health (Dearborn, MI)
- …experience in care management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan Upon Hire ... criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization… more
- Area Agency On Aging 1-b (Southfield, MI)
- …an administrative clinical setting, including 1-2 years Medicaid managed care appeals process & Health/Human Services. + Proven ability to foster and maintain ... organizational, training, and investigative skills. The ability to conduct clinical case/documentation reviews, present findings and appeals recommendations.… more
- McLaren Health Care (Mount Clemens, MI)
- …the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and achieve optimal ... other related duties as required and directed. **Qualifications:** **_Required:_** + Registered Health Information Technician (RHIT), Licensed Practical Nurse … more
- McLaren Health Care (Grand Blanc, MI)
- …**_Required:_** + Associate's degree in nursing or healthcare related field **.** Current Registered Nurse license in the state of Michigan or possess a ... of Medicine Degree **.** **4 years of utilization management, case management, clinical documentation, and/or denials/ appeals experience in an acute healthcare… more
- Molina Healthcare (Warren, MI)
- …hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical … more
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