- CVS Health (OH)
- …care for members. Administers review and resolution of clinical complaints and appeals . Interprets data obtained from clinical records to apply appropriate clinical ... with internal and external support areas. **Required Qualifications** + A Registered Nurse that must hold an unrestricted license in their state of residence,… more
- McLaren Health Care (Mount Clemens, MI)
- …**Qualifications:** **_Required:_** + Registered Health Information Technician (RHIT), Licensed Practical Nurse (LPN), hospital biller, or associate degree. + 5 ... . Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews… 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 ... notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the...Bachelor's Degree (BSN) is highly preferred. * Minimum of Associate 's Degree in Nursing required when accompanied by strong… more
- Veterans Affairs, Veterans Health Administration (Eagan, MN)
- Summary The Home and Community Based Services program Registered Nurse is a member of the interdisciplinary team responsible for providing centralized, standardized, ... right time. Responsibilities **These positions may be filled by a Registered Nurse , Physical Therapist, or Occupational Therapist. These positions are advertised on… more
- US Tech Solutions (Columbia, SC)
- …be extended. + Skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills Behavioral Health or infusion therapy ... line of business. + Previous Medicare experience and /or UR experience/Process Appeals requests/can have experience in either Utilization management or Appeals .… more
- Walgreens (Deerfield, IL)
- …and merchandise. + Provides support within the scope of practice for a nurse and escalating to pharmacist for patient specific medication questions, including side ... Care Management. + May have other responsibilities delegated as specific to nurse specialty and as designated by the specific department, other responsibilities as… more
- Commonwealth Care Alliance (Boston, MA)
- …intensive care management and care delivery. Within the CIC Program, the Registered Nurse (RN) serves as an integral member of an interdisciplinary team for medical ... needs of the defined panel of members, the Registered Nurse will engage in regular assessments, visits at regularly...as approved + Supports escalation of member grievances and appeals + Supports the procurement of network providers and… more
- Mount Sinai Health System (New York, NY)
- …for appeals , On / Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in ... experience may be considered in lieu of educational requirements: Associate Degree + Strong clerical skills required + Very...Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status… more
- Johns Hopkins University (Baltimore, MD)
- The Associate Director is a frontline fundraiser responsible for the qualification, cultivation, solicitation, and stewardship of major gift prospects. The ... Associate Director will identify, engage, and solicit donors at...excellent reputation for training of future nursing leaders and nurse educators, and, among other things, specializes in community… more
- CVS Health (CO)
- …solutions that promote high-quality healthcare for members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. ... teams. Works closely with functional area leadership team (department Associate Managers, Manager, and other key stakeholders such as...+ 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience +… more
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