- 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
- 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
- Children's Mercy Kansas City (Kansas City, MO)
- …utilizing InterQual and/or MCG screening guidelines, and clinical denials/ appeals oversight. Participates in department and hospital performance improvement ... One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire + One...One of the following: Licensed RN - Kansas, Registered Nurse Multistate License Kansas required upon hire + RN… more
- Sharp HealthCare (La Mesa, CA)
- …Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing **Hours** **:** **Shift Start ... acute care nursing experience or case management experience. + California Registered Nurse (RN) - CA Board of Registered Nursing **Preferred Qualifications** +… more
- Sharp HealthCare (San Diego, CA)
- …Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing; Accredited Case Manager (ACM) ... experience or equivalent experience in the healthcare setting. + California Registered Nurse (RN) - CA Board of Registered Nursing **Preferred Qualifications** +… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …* Identifies opportunities for connecting members to group related benefits; eg Nurse Line, Employee Assistance Program, or other specialists with in BCBS Health ... of the department. * Guides member through the Prior Authorization and Appeals process. * Engage providers telephonically in reviewing and understanding treatment… more