- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound clinical judgement to ... integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a...to assist with medical necessity determinations. Key Qualifications: + Registered Nurse with an active unrestricted professional… more
- Molina Healthcare (GA)
- **JOB DESCRIPTION** For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state they reside This position will support ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of… more
- Centene Corporation (Columbia, SC)
- …workplace flexibility. **Position Purpose:** Act as the liaison for all statewide appeals , fair hearings, review organizations, and other external type appeals . ... both State and NCQA requirements. + Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services… more
- CVS Health (Hartford, CT)
- …work. **Position Summary** Responsible for the review and resolution of clinical appeals . Reviews documentation and interprets data obtained from clinical records to ... This position may support UM (includes expedited), MPO, Coding, or Behavioral Health appeals . **Required Qualifications** + Must have active and unrestricted RN … more
- State of Colorado (Denver, CO)
- …(HP III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5019261) Apply Registered Nurse Health Compliance Inspector Home Care - ... Registered Nurse Health Compliance Inspector Home Care -...FAA00094 (HP III RN ) Salary $80,916.00 Annually Location Denver, CO Job Type Full Time… more
- State of Colorado (Golden, CO)
- Registered Nurse I, RN I...of the department's action. For more information about the appeals process, the official appeal form, and how to deliver ... Mountain, Youth Services Center - Golden Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5019028) Apply Registered Nurse I, RN I -… more
- Rochester Regional Health (Rochester, NY)
- …LICENSES / CERTIFICATIONS: BLS - Basic Life Support - American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... Job Title: Registered Nurse IDepartment: Utilization Management Location:...UM review findings, initiate and 1st, 2nd, and/or arbitration appeals as needed. Document in all areas that an… more
- LifePoint Health (Hickory, NC)
- * Registered Nurse ( RN ), Clinical Case Manager* PRN * * *Your experience matters* At Frye Regional Medical Center, we are driven by a profound commitment to ... valued as an employee, but as a person. As a* registered nurse ( RN )*joining our team,...payer guidelines and discharge financial implications. * Manages denial appeals and chart audit reviews. *7. Case Management** Acts… more
- Ascension Health (Wichita, KS)
- …rules and regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Kansas Board of Nursing ... related to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals . + Assess and coordinate discharge planning needs with… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print...RN license. 07 Do you possess an active RN license issued by an Enhanced Nurse Licensure ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4963973) Apply CDOC Registered Nurse ( Nurse I) Salary $7,591.00 - $10,627.00 Monthly… more