- Cognizant (Phoenix, AZ)
- …, and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews .… more
- Elevance Health (Chicago, IL)
- …set of clinical domains, including radiology, cardiology and oncology. The ** Appeals Nurse Reviewer I** is responsible for conducting preauthorization, ... ** Appeals Nurse Reviewer I**...** Appeals Nurse Reviewer I** **Location:** This role...+ Outreach to providers with appeal process instructions. + Clinical review for the RBM and Surgical… more
- Independent Health (Buffalo, NY)
- …a high performing health plan and physician network. The Clinical Reviewer will investigate quality complaints/grievances and appeals , document research of ... benefits and a culture that fosters growth, innovation and collaboration. **Overview** The Clinical Reviewer will be responsible for the collection and review… 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 ... Clinical ) is responsible for the daily oversight of clinical appeals and grievances functions within the...for accuracy, clarity, and cultural appropriateness and sensitivity. + Review and monitor procedures for identifying quality of care… 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 ... **Hours: 8:30am-5pm EST Monday - Friday.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… more
- McLaren Health Care (Grand Blanc, MI)
- …activities and commercial appeals beyond the first level, requiring complex clinical review and appeal letter writing. Responsible for collecting, analyzing, ... commercial insurance. 8. Educates health team colleagues about complex clinical appeals , utilization review , including...utilization review experience + Five years of clinical nurse experience in an acute care… 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 ... an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and...medical information for medical director, consultants and other external review . + Prepares recommendations to either uphold or deny… more
- CVS Health (OH)
- …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
- 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...and internal stakeholders including, but not limited to, Utilization Review , Case Management, Clinical Documentation Integrity, Health… 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 ... critical part in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with CMS requirements,… more
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