- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …18 month commitment before posting for other internal positions\. **Job Qualifications** _License_ + Registered Nurse \( RN \) with active license in the state ... of administrative reviews + Performing comprehensive provider and member appeals , denial interpretation for letters, retrospective claim review, special review… more
- Mount Sinai Health System (Long Island City, NY)
- …field. **Licensing and Certification Requirements (if applicable)** Licensed as a registered nurse , Issuing Agency: Department of Health/Office of Professions ... will direct and manage departmental activities involved in utilization review, appeals management and discharge planning to facilitate the case management process… more
- CVS Health (CO)
- …licensure in non-compact states as needed. + 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of ... times are not permitted. **Required Qualifications** + Active, unrestricted RN license in your state of residence with multistate/compact... Appeals experience in Utilization Management + Must have experience… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …participates in all WC State Reporting and audits. Essential Qualifications + Currently licensed Registered Nurse ( RN ), Nurse Practitioner (NP), or ... all Clinical Services (CS) functions (prior authorization, concurrent review, appeals , case management, disease management, population health) per defined Client… more
- Centene Corporation (Jefferson City, MO)
- …of using code editing software systems in a managed care organization preferred. **Certifications:** RN - Registered Nurse or LPN - Licensed Practical ... + Triages and resolves escalated health plan, Claims department, and provider inquires/ appeals or issues + Cross communication with IT, health plans, vendors, and… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. ... will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and patient...+ Root causes claim denials, reprocesses, and submits claim appeals . + Creates drug cost estimates for both on-label… more
- Alameda Health System (Oakland, CA)
- …nursing background. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. Preferred ... of quality improvement initiatives. + Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals .… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate efficient… more
- Brockton Hospital (Brockton, MA)
- …responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is ... agencies, to coordinate activities involved in medical record review, denials, appeals and reconsideration hearings. Works closely with the physician advisor to… more
- San Antonio Behavioral Health (San Antonio, TX)
- …May consult with staff as needed. Essential Duties: + Collaborate and set standards with registered nurse ( RN ) case managers (CMs) and outcome managers to ... of potential denials and respond appropriately; ie facilitate Physician to Physician appeals when appropriate and assist with construction of appeal letters. +… more