- 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
- 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) ... equivalent experience in the healthcare setting. + California Registered Nurse (RN) - CA Board of Registered Nursing **Preferred...planning, as specified by Sharp, federal, state, and private insurance guidelines. + Core principlesThe RN CM I will… more
- Centene Corporation (Jefferson City, MO)
- …+ Triages and resolves escalated health plan, Claims department, and provider inquires/ appeals or issues + Cross communication with IT, health plans, vendors, and ... software systems in a managed care organization preferred. **Certifications:** RN - Registered Nurse or LPN - Licensed Practical Nurse - State Licensure and/or… more
- Highmark Health (Pittsburgh, PA)
- **Company :** Allegheny Health Network **Job Description :** **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
- 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
- Alameda Health System (San Leandro, CA)
- …other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed. + Encourages patients to develop realistic plans. Makes ... regarding Advance Directives and POLST when requested. + Understands insurance , governmental, and accrediting agency standards to determine criteria concerning… more
- Sacramento County (Sacramento, CA)
- …available to you. These benefits currently include: health, dental and life insurance ; flexible spending account options for dependent care and unreimbursed dental ... RETIREMENT: Social Security and Sacramento County Employees' Retirement System coverage. HEALTH INSURANCE : The County offers a variety of health plan design options… more
- Calvary Hospital (Bronx, NY)
- …to facilitate reimbursement for services provided by the Hospital. Oversees the appeals process for those cases for which reimbursement has been denied. Conducts ... staff. Oversees the interface with the Finance Office regarding pertinent insurance information, eg Medicare, Medicaid, Blue Cross, and Commercial Insurance… more
- Humana (Springfield, IL)
- …gaps in care and access. + Assists enrollees with filing grievances and appeals . + Provides information to enrollee related to MCO requirements, services, and ... a related field. + An active, unrestricted Licensed Practical Nurse (LPN) in the state of Illinois with one...license and are expected to maintain personal vehicle liability insurance . Individuals must carry vehicle insurance in… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …with insurance carriers and MSKCC billing departments to initiate appeals and acquire authorizations for treatment **Key Qualifications:** + Current NYS ... with multidisciplinary team and acts as a liaison to insurance carriers and staff. **Role Overview:** + Provide case...Registered Nurse License/Registration and BSN preferred + At least 2-3… more