- Fallon Health (Worcester, MA)
- …authorization information in QNXT because of determinations made by Authorization Coordinators, Nurse Reviewers and/or Nurse Care Specialists. + Handles an ... contract information, benefits, etc.), including authorization details when requested for appeals . + Distributes departmental facsimiles; checks Right Fax no less… more
- City and County of San Francisco (San Francisco, CA)
- …of experience as a Licensed Psychiatric Technician or a Licensed Vocational Nurse providing psychiatric nursing care in a skilled facility or psychiatric acute ... permanent or temporary (including an interim permit) California Licensed Vocational Nurse License or Licensed Psychiatric Technician License. Applicants must meet… more
- Rochester Regional Health (Rochester, NY)
- …hospital and payors, ensuring accurate communication of clinical information, supporting appeals , and optimizing benefit use. + Collaborates with care teams to ... care experience + Licensed in New York State as a Registered Nurse PREFERRED QUALIFICATIONS: + Case Management or Utilization Management experience + Bachelor's… more
- Centene Corporation (Carson City, NV)
- …Systems), HOS (Health Outcomes Survey), CTMs (Complaints to Medicare), Disenrollments, Appeals , and Grievances. + Collaborates with Provider Relations and other ... + Driver's License required. + Pharmacy Technician, Medical Assistant Licensed Vocational Nurse , Licensed Practical Nurse , Social Work licensure preferred. Pay… more
- Highmark Health (Monroeville, PA)
- …relationships across the organization in a community setting. **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care and manages ... contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials/ appeals and retrospective payer audit denials. Collaboratively formulates plans… more
- CommonSpirit Health (Westminster, CO)
- …provide excellent patient-centered care with teamwork and compassion. Our department appeals to anyone interested in furthering their skillset, specifically in the ... and achieve professional fulfillment united in humankindness. As a Registered Nurse (RN) you will assume responsibility and accountability for: + Facilitating,… more
- TEKsystems (Los Angeles, CA)
- …compliance, and proper adjudication. This role is ideal for a Licensed Vocational Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization ... review activities + Participate in special projects related to claim denials and appeals Required Qualifications: + Active LVN or RN license (California) + 2+ years… more
- Molina Healthcare (Tacoma, WA)
- 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 of high ... set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. JOB DESCRIPTION Job...equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- CommonSpirit Health (Westminster, CO)
- …pre-and post-operative care for orthopedic, abdominal, and general surgeries. 5 West appeals to anyone interested in broadening their skillset as we receive overflow ... you grow and recognize your contributions to clinical excellence! As a Nurse with us you will assume responsibility and accountability for facilitating,… more
- Sharp HealthCare (San Diego, CA)
- …Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing **Hours** **:** **Shift Start ... case management, utilization review, care coordination experience. + California Registered Nurse (RN) - CA Board of Registered Nursing **Preferred Qualifications** +… more