- 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
- 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 ... Participate in special projects related to claim denials and appeals Required Qualifications: + Active LVN or RN license...- Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and… 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 ... will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical… 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
- 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
- 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
- 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
- Corewell Health (Dearborn, MI)
- …when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization for care and ... review, home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan Upon Hire required...more! + Optional identity theft protection, home and auto insurance , pet insurance + Traditional and Roth… more
- System One (Las Vegas, NV)
- …notify care management team of LTSS approvals and denials, and support the appeals process as needed + Collaborate with Care Managers and/or providers to collect ... and standards of care Licensure and Certification: + Current, unrestricted Registered Nurse (RN), Licensed Social Worker (LSW), or Licensed Independent Social Worker… more