- Molina Healthcare (WI)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals ... regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and… more
- BayCare Health System (Clearwater, FL)
- …team member be working remotely?** Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Clinical Appeals Nurse - Health Plan **Location** ... review processes including how to analyze and research clinical issues and the appeals and grievance...of experience with case management and/or clinical appeals or claims. + Registered Nurse **Facility:**… more
- University of Washington (Seattle, WA)
- …**UW Medicine's Patient Financial Services Department** has an outstanding opportunity for a ** Clinical Appeals and Disputes Nurse .** **WORK SCHEDULE** + ... FTE + 100% Remote + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ...and communicated payer decisions in a timely manner + Review clinical denials and initiate appeals… more
- HCA Healthcare (Salem, VA)
- …**Introduction** Do you want to join an organization that invests in you as a Clinical Nurse Reviewer ? At Parallon, you come first. HCA Healthcare has ... make a difference. We are looking for a dedicated Clinical Nurse Reviewer like you...eligibility and contract requirements. **Responsibilities:** + Perform a retrospective review of medical records using clinical expertise… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & Grievances ... Clinical ) is responsible for the daily oversight of clinical appeals and grievances functions within the...for accuracy, clarity, and cultural appropriateness and sensitivity. + Review and monitor procedures for identifying quality of care… more
- Elevance Health (FL)
- ** 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**...including ensuring accurate entry, investigation, and analysis of state appeals ; summarizing medical information for review by… more
- Evolent (Springfield, IL)
- …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...work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators… more
- CVS Health (Columbus, OH)
- …utilizing templates in Word, and typing on the computer. + Responsible for the review and resolution of clinical appeals . + Reviews documentation and ... day. **Position Summary** CVS Aetna is seeking a dedicated ** Appeals Nurse Consultant** to join our remote...3+ years clinical experience. **Preferred Qualifications** + Appeals , Managed Care, or Utilization Review experience.… more
- BJC HealthCare (St. Louis, MO)
- …and VitalWare to review documentation to write a compelling appeal. The Clinical Appeals Specialist must be able to identify trends and escalate them ... Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist with infusion... clinical denials and sending them to a nurse to review and appeal and then… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more