- Elevance Health (Chicago, IL)
- ** Appeals Nurse Reviewer I** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... expanding set of clinical domains, including radiology, cardiology and oncology. The ** Appeals Nurse Reviewer I** is responsible for conducting preauthorization,… more
- Elevance Health (Atlanta, GA)
- ** 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
- CVS Health (OH)
- …care for members. Administers review and resolution of clinical complaints and appeals . Interprets data obtained from clinical records to apply appropriate clinical ... with internal and external support areas. **Required Qualifications** + A Registered Nurse that must hold an unrestricted license in their state of residence,… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... the safety net required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily… more
- McLaren Health Care (Grand Blanc, MI)
- **Position Summary:** Responsible for coordinating the appeals process for third party payer denials, primarily RAC-related activities and commercial appeals ... physicians, other team members, payers, and administrators regarding denial and appeals cases reviews and process. 6. Maintains accurate complete documentation of… more
- Cognizant (Phoenix, AZ)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… 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
- Centene Corporation (New York, NY)
- …Friday.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more
- McLaren Health Care (Mount Clemens, MI)
- …. Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews ... of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and achieve optimal payment for… more
- BronxCare Health System (Bronx, NY)
- …the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to ... identification of patterns and trends identified during the course of appeals preparation. Conduct departmental performance improvement audits, analyze findings and… more
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