- Stanford Health Care (Palo Alto, CA)
- …180 Days or + CCDS - Cert Clinical Document Spec required within 180 Days + RN - Registered Nurse - State Licensure And/Or Compact State Licensure required ... and comprehensive appeal letters to payors after a detailed review of medical records. Ensure compliance with...likelihood of a successful appeal. + Proofreading and Editing: Review and edit appeals for clarity and… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …BroadPath is seeking a highly motivated and results-driven **UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical ... to enhance understanding of criteria application, benefit use, and the appeal, External Medical Review (EMR), and Fair Hearing processes + Coordinate: Ensures… more
- Alameda Health System (San Leandro, CA)
- …AHA-American Heart Association. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. **PAY RANGE** ... SLH Case Manager RN + San Leandro, CA + San Leandro...contacts with payers conducting phone reviews and initiates denial appeals as needed. + Encourages patients to develop realistic… more
- St. Luke's University Health Network (Allentown, PA)
- …ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- Centene Corporation (Trenton, NJ)
- …State Licensure required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… more
- AmeriHealth Caritas (Philadelphia, PA)
- …+ Process appeals , ensuring compliance with all regulatory milestones + Review medical records to identify Hospital-Acquired Conditions (HAC), ensure proper ... functions in the evaluation of appeals + Review appeal cases and ensure the Medical ...a managed care organization **Licensure:** + Current and unrestricted Registered Nurse ( RN ) licensure or… more
- Centene Corporation (Salem, OR)
- …preferred Must have a current RN or LPN** **Oregon state license **Utilization review , case management, and appeals experience in a managed care setting is ... State and NCQA requirements. + Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of… more
- HCA Healthcare (San Antonio, TX)
- …Do you want to join an organization that invests in you as an Inpatient Authorization Review Services Registered Nurse or Licensed Practical Nurse -NICU ... difference. We are looking for a dedicated Inpatient Authorization Review Services Registered Nurse or...care contracting, experienced preferred. + Currently licensed as a registered nurse ( RN ) in the… more
- HCA Healthcare (Las Vegas, NV)
- …individual is recognized. Submit your application for the opportunity below: Inpatient Authorization Review Services- Registered Nurse or Licensed Practical ... vary by location._** We are seeking a Inpatient Authorization Review Services- Registered Nurse or...care contracting, experienced preferred. + Currently licensed as a registered nurse ( RN ) in the… more
- Elevance Health (Atlanta, GA)
- …preferred. + 3 years of clinical experience as a Registered Nurse is strongly preferred. + Experience reviewing medical records, investigation, and/or ... ** Nurse Appeals ** **Location:** This role enables...and forwards to Medical Director for final review and decision. + Ensures that appeals … more
