- Cognizant (Phoenix, AZ)
- …cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . ... Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...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
- 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
- Northwell Health (Melville, NY)
- …needed. Preferred Skills 3-5 years experience in Utilization Review, Case Management, and Clinical Appeals . 3-5 years of acute inpatient clinical experience. ... with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to...date. Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications… 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
- Nuvance Health (Danbury, CT)
- *Description* *FULL TIME DAY SHIFTS- VARIABLE HOURS / WEEKEND ROTATIONS REQUIRED* * *Hybrid/ Remote * * *Summary:* The purpose of the Denial Prevention Nurse is to ... 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
- Stanford Health Care (Palo Alto, CA)
- …role in the Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and denials. This position ... regulations, payor policies, and industry best practices related to clinical appeals and denials management. Evaluate internal...Spec required within 180 Days + RN - Registered Nurse - State Licensure And/Or Compact State Licensure required… more
- Providence (OR)
- …best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide care ... nearing end of life + Care management services include: nurse education, care coordination and general assistance with managing...care to our members **Providence Health Plan welcomes 100% remote work to residents who reside in the following… more
- Virtua Health (Mount Laurel, NJ)
- …over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques ... neurosciences, and the Children's Hospital of Philadelphia for pediatrics. Location: 100% Remote Currently Virtua welcomes candidates for 100% remote positions… more
- State of Colorado (Denver, CO)
- Charge Nurse RN II - CO Mental Health Hospital in Fort Logan (S. Denver) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5097141) Apply Charge ... Nurse RN II - CO Mental Health Hospital in...coordinates and implements medical and psychiatric crisis intervention in clinical emergencies assuring compliance with nursing standards and policies/procedures.… more
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