- 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
- Cognizant (Springfield, IL)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… 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
- CVS Health (IL)
- …in accordance with contract. Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) ... to incoming correspondence and internal referrals. Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs… more
- Humana (Springfield, IL)
- …gaps in care and access. + Assists enrollees with filing grievances and appeals . + Provides information to enrollee related to MCO requirements, services, and ... social work, human services, or a related field. + An active, unrestricted Licensed Practical Nurse (LPN) in the state of Illinois with one (1) year of experience in… more