- Cedars-Sinai (CA)
- …Hospitals. **Why work here?** Beyond outstanding employee benefits including health and dental insurance , vacation, and a 403(b) we take pride in hiring the best ... Investigates, processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate policy. + Begins… more
- Actalent (Rancho Cordova, CA)
- Utilization Review Nurse About the Role We're looking for a Utilization Review (UR) Nurse to join our team and support high‑quality, cost‑effective patient care ... additional clinical information when needed + Support denial management, including appeals and peer‑to‑peer review processes + Ensure regulatory compliance with… more
- Molina Healthcare (Madison, WI)
- …and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends ... chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review and manages the denial… more
- University of Washington (Seattle, WA)
- …patients, their families, and their caregivers + Manage prescriptions and assist with insurance appeals for specialty medications + Handle the care coordination ... Care Center** has an outstanding opportunity for a **Registered Nurse .** **WORK SCHEDULE** + 40 hours per week +...experience + Active licensure to practice as a Registered Nurse in Washington State + Active BLS + IV… more
- International Medical Group (Indianapolis, IN)
- As one of the world's top International Medical Insurance companies, IMG helps individuals and companies of all sizes. Every second of every day, vacationers, those ... review and /or /evacuation/repatriation. Work as a liaison between the Insured, the insurance carrier and the Insured's healthcare team to meet the requirements of… more
- Crouse Hospital (Syracuse, NY)
- …department, including Utilization Management, Discharge Planning and Denials and Appeals functions. + Assessing workflow related to readmission prevention, length ... Care Coordination Manager Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree +...Dental, Vision, FSA, and 401K. + Company paid life insurance . + Tuition Assistance and Workforce Development Opportunities. +… more
- Rush University Medical Center (Chicago, IL)
- …of each case. **Summary:** This position reviews initial clinical denials, document appeals for clinical inpatient denials, conducts appeals as appropriate. ... outcomes, identify trends and work collaboratively with clinical providers, coders, insurance companies and revenue cycle leadership to prevent future clinical… more
- Houston Methodist (Sugar Land, TX)
- …utilization review activities, and monitoring the clinical denial management and appeals process, as applicable, in collaboration with clinical team partners. This ... and determines the need for or feasibility of submitting appeals . + Facilitates communication with payors and external case...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
- Clark County, NV (Las Vegas, NV)
- …+ Pharmacy Benefits (30, 90-day retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and Dispatch Health + Retiree ... insurance - eligible after 5 years of service +...applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +… more
- State of Colorado (Canon City, CO)
- …and dental health plans; + Short and long term disability coverage; + Paid life insurance ; + 11 paid holidays per year plus vacation and sick leave; + Wellness ... Qualifications: + A current, valid license as a Registered Nurse from the Colorado Board of Nursing, or any...of the department's action. For more information about the appeals process, the official appeal form, and how to… more