- Elevance Health (Indianapolis, IN)
- **Nurse Appeals ** **Location: Indiana** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... unless an accommodation is granted as required by law. The **Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals… more
- Molina Healthcare (Salt Lake City, UT)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests ... strategy to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours: Monday- Friday 8:00am - 5:00pm… more
- Elevance Health (Cleveland, OH)
- …and appeals process is strongly preferred. .Basic knowledge of Medicare and Medicaid guidelines is preferred. .Proficiency in Microsoft Suite Products (eg ... **Nurse Appeals -Licensed Nurse** **Location** : Ohio, candidates must...and is dependent on court hearing schedules. The Nurse Appeals is responsible for investigating and processing and medical… more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... that purpose. Job Summary The Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with...and/or case management setting, At least 2 years in Medicare / Medicaid in a managed care/ health plan environment.… more
- Molina Healthcare (Rio Rancho, NM)
- …in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Enters denials and ... requests for appeals into information system and prepares documentation for further review. * Researches claims issues utilizing systems and other available… more
- Texas Health Resources (Arlington, TX)
- Clinical Reviews, Denial and Appeals RN Bring your passion to THR so we are Better + Together Work location: Remote (Local candidates only) Work hours: Monday - ... or InterQual criteria required + Case management experience preferred + Denials and Appeals experience preferred + RN license to practice in the state of Texas… more
- WMCHealth (Valhalla, NY)
- Denials and Appeals Mngmt Cord Company: WMC Advanced Physician Services PC City/State: Valhalla, NY Category: Clerical/Administrative Support Department: Clinical ... the monies lost to insurance companies due to denials. Generate appropriate appeals , both retrospective and concurrent, based on medical necessity criteria. 2.… more
- Nuvance Health (Danbury, CT)
- …This role is instrumental in liaising with all above parties to submit provider appeals to insurance companies including Medicare and Medicaid for the Nuvance ... Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician Advisors (PAs) and other stakeholders in ensuring… more
- Southwest Nursing Center (Fort Worth, TX)
- …billing and ensures that the Centralized Statement process is followed. + Manages Medicare ADRs and appeals per established procedure. + Other duties, ... responsibilities and activities may change or assigned at any time with or without notice. Southwest Nursing Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type… more
- CVS Health (Phoenix, AZ)
- …+ Must reside in Arizona. + At least 6 months of experience with Medicare and Medicaid programs. + At least 6 months of experience with behavioral health ... systems related to individuals with serious mental illness. + Proficiency with typing and basic computer knowledge. + Ability to navigate multiple systems to retrieve data during calls. + Ability to critically assess the information provided by callers to… more