- Molina Healthcare (Salt Lake City, UT)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that ... regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and… more
- CVS Health (Atlanta, GA)
- …with heart, each and every day. **Position Summary** CVS Aetna is seeking a dedicated ** Appeals Nurse Consultant** to join our remote team. In this role, you ... critical role in ensuring fair and accurate resolution of clinical appeals by applying sound clinical...+ This position may support UM (includes expedited), MPO, Coding , or Behavioral Health appeals . + This… more
- St. Luke's University Health Network (Allentown, PA)
- …and/or formal meetings with auditor or payor representatives in defense of coding appeals , as needed. + Maintain necessary audit/appeal activity documents ... patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient...and CDMP Managers for education of the medical staff, clinical documentation professionals and the coding professionals… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview: ;** The Clinical Appeals Reviewer is responsible for processing appeals and ensuring all milestones are met in compliance with regulatory ... a case for determination, interacting directly with providers to obtain additional clinical information, and with members or their advocates to understand the full… more
- McLaren Health Care (Mount Pleasant, 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 ... + Certified Medical Coder, Certified in Healthcare Compliance, Certified Coding Specialist, or Certified Clinical Documentation Specialist certifications more
- Stanford Health Care (Palo Alto, CA)
- …Government Audit Analyst and Appeals Specialist II will collaborate with clinical staff, coding professionals, and external stakeholders to ensure timely and ... role in the Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and denials. This position… more
- Molina Healthcare (Buffalo, NY)
- …(Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding . **Job Summary** Provides support for medical ... a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/ appeals . + Provides training and support to clinical peers. +… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- …defense, LifeNet and special focus audits and reports findings. + Serves as a clinical resource for coding / denial management and customer service issues. + ... + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and...supporting documentation, as well as facilitates the completion of appeals in a timely manner. + Prepares trend and… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Staff Nurse *to join our Utilization Management department for the/Emergency Department / This position is a*0.6 FTE (6 ... Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical necessity, appropriateness,… more
- Garnet Health (Middletown, NY)
- …Garnet Health Medical Center. Responsibilities Under the direction of The Administrator, Coding & Clinical Documentation Improvement and Patient Access, the ... knowledge, required* Exceptional ability to communicate effectively with physicians and other clinical professional staff.* Knowledge of DRG and Coding appeal… more