- 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
- Elevance Health (FL)
- ** Nurse Appeals - Litigation & Legal Support** **In Office Expectation:** This role is **Virtual** ; This role enables associates to work virtually full-time, ... in hours will be necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support** is responsible for investigating and… more
- Evolent (Springfield, IL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- HCA Healthcare (Nashville, TN)
- …UT, VA). Do you want to join an organization that invests in you as a Clinical Appeals Nurse RN? At Parallon, you come first. HCA Healthcare has committed up to ... plans (accident, critical illness, hospital indemnity), auto and home insurance , identity theft protection, legal counseling, long-term care coverage,...a difference. We are looking for a dedicated Clinical Appeals Nurse RN like you to be… more
- Molina Healthcare (Kearney, NE)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests ... reviews of previously denied cases in which a formal appeals request has been made or upon request by...chief medical officer for administrative law judge pre-hearings, state insurance commission, and meet and confers. * Represents Molina… more
- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and electronic ... format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible to develop a… more
- BJC HealthCare (St. Louis, MO)
- …experience) **Additional Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist with infusion appeals for both government ... be handling clinical denials and sending them to a nurse to review and appeal and then they will...clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be able to multi-task and maintain… more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with the development of a… more
- St. Luke's University Health Network (Allentown, PA)
- …a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... APR-DRG for the purpose of appealing proposed DRG and coding changes by insurance providers or their respective auditors JOB DUTIES AND RESPONSIBILITIES: + Conduct… more
- Integra Partners (Troy, MI)
- …care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key role in collaborating ... Medical Director to perform benefit and medical necessity reviews and appeals within an NCQA-compliant UM program. Salary: $60,000.00/annual JOB QUALIFICATIONS:… more