- Ochsner Health (New Orleans, LA)
- …it relates to all medical necessity audits. **Education** Required - Registered Nurse Diploma Preferred - Associate's or Bachelor's degree in Nursing **Work ... Appeal/Denial Management **Certifications** Required - Current State of Louisiana Registered Nurse (RN) License Preferred - Certification in Case Management (CCM) or… more
- Centene Corporation (Baton Rouge, LA)
- …expectations and lead clinical quality initiatives. Review clinical information for appeals to determine medical necessity of services, prepare reviews for cases, ... act as the liaison for appeals and fair hearings. + Develop and implement the...Administration required **Experience in Behavioral Healthcare field preferred:** Registered Nurse (RN) certification, Licensed Mental Health Professional (LMHC), or… more
- Ochsner Health (Lafayette, LA)
- …systems (CMS) regulations, compliance and quality metrics. Experience managing denials and appeals of all payer cases in a timely and organized manner. Preferred ... or other related MCO departments/functions. **Certifications** Required - Current registered nurse (RN) license in state of practice. *MSW accepted in lieu… more