- Centene Corporation (Sacramento, CA)
- …State Licensure required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... a fresh perspective on workplace flexibility. This position requires RN California Licensure and for candidates to have a...Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical… more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... with dynamic goals resulting in the full and fair review of appeals and grievances designed to...and utilization management, and systems software used in processing appeals . + Knowledge and understanding of medical … more
- VNS Health (Manhattan, NY)
- …Do + Responsible for direct oversight and the day to day management of clinical appeals review processes within Appeals & Grievances Department. + Manages ... Health Plans is seeking a dedicated Manager, Grievance and Appeals ( RN )to lead the daily operations of...of care concerns and any other inquires requiring clinical review for medical necessity, appropriateness of service… more
- ManpowerGroup (Columbia, SC)
- …School of Nursing. + 2 years clinical experience plus 1 year in utilization/ medical review , quality assurance, or home health. + An active, unrestricted ... Appeals , you will be part of the clinical review department supporting the appeals team. The...benefit analysis to determine if the requested services meet medical necessity guidelines. + Document decisions within mandated timeframes… more
- R1 RCM (Chicago, IL)
- …orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to draft appeals of denied and underpaid ... experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical...external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + An active CCS,… more
- R1 RCM (Chicago, IL)
- …team members and 1:1 meetings on a routine basis. **Required Skills:** + Active Registered Nurse license + Active AHIMA or AAPC Coding Certification including ... experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines...coders and coding team members who conduct a comprehensive review of coding denials and formulate appeals … more
- R1 RCM (Chicago, IL)
- …conduct a comprehensive review of clinical denials and formulate appeals based on clinical documentation, evidence-based medical necessity criteria, ... identify targeted areas for additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay… more
- Nuvance Health (Danbury, CT)
- …in nursing, health administration, or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience ... leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical...medical necessity outreach, and feedback to the utilization review team on denial outcomes. * *Discharge Planning &… more
- Ascension Health (Tulsa, OK)
- …management rules and regulations. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Oklahoma Board of Nursing ... cases. + Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals . +… more
- Mount Sinai Health System (Long Island City, NY)
- …field. **Licensing and Certification Requirements (if applicable)** Licensed as a registered nurse , Issuing Agency: Department of Health/Office of Professions ... The Director will direct and manage departmental activities involved in utilization review , appeals management and discharge planning to facilitate the case… more