- Molina Healthcare (GA)
- …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously ... For this position we are seeking a (RN) Registered Nurse who must be licensed for the state they...request authorization. Strongly prefer candidates with a background in appeals and grievances. Excellent computer multi-tasking skills and good… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …**Description** We're seeking under the direction of the **Utilization Management Appeals Professional, Registered Nurse ** is responsible for managing clinical ... in Administrative Law Judge (ALJ) hearings and if required, Medicare Appeals Council. + Primary duties and responsibilities: Participates in external reviews… more
- Elevance Health (Norfolk, VA)
- ** Nurse Appeals ** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... employment, unless an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- Evolent (Montgomery, AL)
- …Stay for the culture. **What You'll Be Doing:** Job Description The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part ... of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent… more
- Mount Sinai Health System (New York, NY)
- …for appeals , On / Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in ... department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status of… more
- Guidehouse (New York, NY)
- **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** + Performs chart review ... of identified patients to identify quality, timeliness and appropriateness of patient care + Conducts admission reviews for Medicare, Medicaid beneficiaries, as well as private insurers and self-pay patients, based on appropriate guidelines + Uses these… more
- Henry Ford Health System (Troy, MI)
- General Summary: The Clinical Manager, Medical Appeals supports appeals team members to plan, direct, evaluate, coordinate, and manage the activities associated ... with the Medical Appeals as it relates to key HAP initiatives and... and Grievance. Education and Experience Required: + Registered Nurse with current Michigan licensure. + Bachelor's Degree in… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and ... organizing and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety of sources. **ESSENTIAL FUNCTIONS:**… more
- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and electronic ... format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the...electronic database system. The Appeal Manager should be a nurse who has 3-5 years or more of experience… more
- R1 RCM (Boise, ID)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Supervisor** , you will help support clinicians who conduct a ... comprehensive review of clinical denials and formulate appeals based on clinical documentation, evidence-based medical necessity criteria, physician documentation,… more
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