- Cognizant (Phoenix, AZ)
- …cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . ... have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical ...stand out** . Epic experience . Experience in drafting appeals disputing inpatient clinical validations audits is… 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 ... (A&G) & General Operations ( Clinical ) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals & Grievances… more
- McLaren Health Care (Grand Blanc, MI)
- …and commercial insurance. 8. Educates health team colleagues about complex clinical appeals , utilization review, including role, responsibilities tools, and ... management, clinical documentation, or utilization review experience + Five years of clinical nurse experience in an acute care setting + American Case… more
- Elevance Health (Atlanta, GA)
- ** Nurse Appeals ** **Hybrid 1:** This role.../grievances/quality of care issues and is a resource for clinical and non clinical team members in ... employment, unless an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- Centene Corporation (New York, NY)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... license.** **Hours: 8:30am-5pm EST Monday - Friday.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing… more
- CVS Health (OH)
- …support cost-effective quality care for members. Administers review and resolution of clinical complaints and appeals . Interprets data obtained from clinical ... regulatory and accreditation requirements for members and providers. Coordinates clinical resolutions with internal and external support areas. **Required… more
- Elevance Health (Chicago, IL)
- …set of clinical domains, including radiology, cardiology and oncology. The ** Appeals Nurse Reviewer I** is responsible for conducting preauthorization, out ... ** Appeals Nurse Reviewer I** **Location:** This...reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. **How you will make an… more
- Catholic Health (Buffalo, NY)
- …with varied hours based on role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for the ... people, carrying out and documenting the appeals process for denied claims denied due to reasons...denied due to reasons including, but not limited to clinical documentation/support for diagnostic related grouping (DRG) assignment, inpatient… more
- Nuvance Health (Danbury, CT)
- …REQUIRED* * *Hybrid/Remote* * *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within ... in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- McLaren Health Care (Mount Clemens, MI)
- …outcomes and fulfills the obligation and responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer ... . Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews… more
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