- Elevance Health (Rancho Cordova, CA)
- **Nurse Appeals - Licensed RN Nurse** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live in the state of California ... locations. **Shift:** Monday to Friday from 8:00-5:00 pm PT The **Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals… more
- Iowa Department of Administrative Services (Des Moines, IA)
- Assistant Attorney General- Criminal Appeals Section Print (https://www.governmentjobs.com/careers/iowa/jobs/newprint/4519255) Assistant Attorney General- Criminal ... Appeals Section Salary $57,636.80 - $139,318.40 Annually Location Des...General Brenna Bird seeks an Attorney for the Criminal Appeals Section. Description: Attorneys in this section primarily handle… more
- Kepro (Indianapolis, IN)
- …in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Job Summary: Our Utilization ... Management Appeals Nurse - LPN/RN will help orchestrate the seamless resolution of appeals in line with health regulations. He or She will collaborate with… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the… more
- Centene Corporation (PA)
- …Purpose:** Analyze and resolve verbal and written claims and authorization grievance/ appeals from providers and members. Resolve all State inquires related to ... complaints, grievances and appeals . + Review and process member and provider grievances...+ Review and process member and provider grievances and appeals within federal, state and organizational regulations and policies… more
- Centene Corporation (Columbus, OH)
- …Ohio **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more
- Corewell Health (Grand Rapids, MI)
- …departments. Serves as a mentor/trainer to other team members. The Senior Appeals Analyst makes decisions on moderately complex issues regarding technical approach ... Essential Functions + Responsible for complex and thorough investigation of appeals , external complaints, and fair hearing reviews including: formulate action plan… more
- Molina Healthcare (TX)
- …discussed during our interview process._** **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions ... for appeals outcomes... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied… more
- Elevance Health (Rancho Cordova, CA)
- **Manager II Grievance/ Appeals - Claims Support** **Location: *CA Residential Requirement** This position will work a hybrid model (remote and office). Ideal ... within 50 miles of one of our PulsePoint locations. The **Manager II Grievance/ Appeals ** is responsible for management oversight of grievances and appeals … more
- Trinity Health (Farmington Hills, MI)
- …Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing ... of appeals as required by payers, in addition to promoting...communication and follow-up processes related to rejections, denials and appeals , ensuring that such activities are tracked, trended and… more