- Humana (Indianapolis, IN)
- **Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals . The Appeals Nurse ... and independent determination of the appropriate courses of action. The Appeals Nurse 2 reviews documentation and interprets data obtained from clinical records… more
- Elevance Health (Indianapolis, IN)
- ** Nurse Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... shift between those hours, including holidays on a rotational basis. The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- Elevance Health (Indianapolis, IN)
- ** Nurse Appeals ** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... employment, unless an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- Cummins Behavioral Health Systems Inc. (Avon, IN)
- …organization, Cummins is your kind of place. * If being part of a learning organization appeals to you, get in touch with us. * If you seek an employer with ethical ... in multiple counties throughout central and west central Indiana. The Advanced Practice Nurse , under the supervision of a Staff Psychiatrist, will augment our staff… more
- International Medical Group (Indianapolis, IN)
- …outpatient management of assistance cases. + Knowledge of the Non-certification process and Appeals process including logs and time frames. + Participate in the on ... as assigned. QUALIFICATIONS + Current and active Nursing license - Registered Nurse + Minimum two years acute hospital-based experience providing direct patient care… more
- CVS Health (Indianapolis, IN)
- …accordance with contract. + Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) ... incoming correspondence and internal referrals. + Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs… more
- Sharecare (Indianapolis, IN)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more