- Molina Healthcare (Salt Lake City, UT)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal appeals clinical processes - ensuring that ... to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- MVP Health Care (Tarrytown, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join #TeamMVP. If you have a ... passion for patient-centered advocacy, clinical precision and regulatory compliance this is an opportunity...UM platforms. + Familiarity with CMS regulations and appeals processes. + Ability to work independently and manage… more
- Centene Corporation (Salem, OR)
- …analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters ... for member and provider clinical appeals and ensure letters are compliant...assigned + Complies with all policies and standards **Education/Experience:** RN with 4+ years of clinical nursing… more
- Molina Healthcare (Long Beach, CA)
- …skills. * Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** * Registered Nurse ( RN ). License must be active and ... Oversight Nurse ** is responsible for ensuring that Molina Healthcare's UM delegates are compliant with all applicable State, CMS, and NCQA requirements,… more
- Cedars-Sinai (CA)
- …as a condition of continued employment. **Req ID** : 13443 **Working Title** : Registered Nurse Care Coordinator- Inpatient Specialty Program - 8 Hour Days $5K ... care. Use Milliman and Interqual guidelines as necessary. + Collaborates with clinical teams and practices to ensure synchronization of sub-areas' operations to… more
- Molina Healthcare (Los Angeles, CA)
- …skills. * Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** * Registered Nurse ( RN ). License must be active and ... JOB DESCRIPTION **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for overseeing… more
- US Tech Solutions (Columbia, SC)
- …if progressing well, can be moved to work remote. + Prefer 2 yrs. UM and/or appeals experience. + Experience with prior insurance, utilization management, case ... temp to hire)** **Job Description:** + Must be an RN in SC and have an active and unrestricted...appeals by both member and provider based on clinical documentation, contractual requirements, governing agencies, policies and procedures,… more
- TEKsystems (Rockville, MD)
- …company, is hiring for a Remote Quality Assurance Analyst and is looking for UM Nursing experience. Job Description: + Their process includes the following: + Double ... up well, grammatically correct, and double check that the clinical information and explanation makes sense. + They will...is going to be important. + Going through the appeals and reviewing all types of Prior Authorizations. +… more
- HCA Healthcare (Gainesville, FL)
- …that invests in you as a Inpatient Authorization Review Services Behavioral Health Registered Nurse ( RN ) or Licensed Mental Health Counselor (LMHC) ... the account being denied by the payor that require clinical expertise. Communicates with third party payors to resolve...care contracting, experienced preferred. + Currently licensed as a registered nurse ( RN ) in the… more
- Corewell Health (Grand Rapids, MI)
- … clinical nursing and or case management/managed care or related field Preferred + Registered Nurse ( RN ) - State of Michigan Upon Hire required + ... (4 hours), mostly remote, occasional on-site About the Department: RN UM - Supporting the insurance coordination...insurance prior authorizations, initial reviews, continuous stay reviews and appeals . Nurse Care Manager - Plans and… more