- 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
- CareFirst (Baltimore, MD)
- …a compliant appeal process with dynamic goals resulting in the full and fair review of appeals and designed to achieve corporate objectives and advance ... Federal and accreditation requirements. Ensures appropriate and complete resolution of appeals , Regulatory complaints and External review requests. Performs… more
- CareFirst (Baltimore, MD)
- …leading in a managed care or health insurance environment with a focus on Clinical Medical Review and Appeals and Grievances. **Preferred Qualifications:** + ... services and provider types. + Understanding of the interdependencies between Medical Policy, Clinical Medical Review and Appeals and Grievances. + Ability… more
- BronxCare Health System (Bronx, NY)
- …arrive in letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal ... Overview The Appeals Manager is responsible to assist in the...for timely response by the department physician advisors and clinical staff. Qualifications - NYS Registered Nurse … more
- Nuvance Health (Danbury, CT)
- *Description* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within the first 12-24 hours ... critical part in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with CMS requirements,… more
- LA Care Health Plan (Los Angeles, CA)
- …in Nursing for Registered Nurses Experience Required: At least 8 years of clinical appeals and grievances experience in a managed care, utilization management ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical... unit. This position is responsible for the quality review of complex and/or escalated clinical A&G… more
- Northwell Health (Melville, NY)
- …+ Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect ... decisions and billing status and ensures compliance with the Utilization Review standard and regulations. + Performs concurrent and retrospective utilization… more
- Northwell Health (Melville, NY)
- …stay. Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately ... and billing status and ensures compliance with the Utilization Review standard and regulations. Performs concurrent and retrospective utilization management… more
- UNC Health Care (Kinston, NC)
- …for all audit and appeals work activities. Assists with documentation review to support the clinical documentation specialists and Patient Financial ... + Minimum 3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review , care management, or compliance experience… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the ... Nurse issued by the State of Minnesota. **Title:** *Staff Nurse - Utilization Review (ED)* **Location:** *MN-Minneapolis-Downtown Campus* **Requisition ID:**… more