- Molina Healthcare (MI)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... _For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...with internet connectivity of high speed required._ **Job Summary** Clinical Appeals is responsible for making appropriate… more
- R1 RCM (Detroit, MI)
- …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help our ... remote, production-driven position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical… more
- R1 RCM (Detroit, MI)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Supervisor** , you will help support clinicians ... position. **Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor...additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay… more
- CenterWell (Lansing, MI)
- …to, managing and monitoring all payer requests for additional documentation (ADR), appeals and denials. Works with branch staff to gather required information and ... collaborates with branch and billing staff to determine appropriate response, manages appeals process. + Monitors and responds to all requests related to revenue… more
- Prime Therapeutics (Lansing, MI)
- …and enters data of these cases in web-based application and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings ... work visa or residency sponsorship. **Additional Qualifications** + Registered Nurse (RN). + 5 years of post-degree clinical... Nurse (RN). + 5 years of post-degree clinical experience. + Experience in managed care, specialty drugs,… more
- Corewell Health (Farmington Hills, MI)
- …criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization ... management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan License Upon Hire required How Corewell… more
- Corewell Health (Southfield, MI)
- …policy and procedure and payer requests. + Routinely collaborates with the System Clinical Appeals and Revenue Cycle departments to expedite billing and ... or related field. + Hospital utilization review/utilization management experience. Preferred + Clinical appeals experience. Preferred + 2 years of relevant… more
- State of Michigan (Lansing, MI)
- …Inclusion . Reviews, coordinates and represents the Department on statewide appeals of preadmission screenings/annual resident reviews Medicaid recoveries before the ... Departments Appeals Division. Represents the Department on appeals ...make determinations. This position has a statewide responsibility for clinical assessment reviews and activities related to making determinations… more
- Molina Healthcare (Warren, MI)
- …state, and local laws and regulatory requirements affecting the medical and clinical staff. **Job Duties** + Provides medical oversight and expertise in ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
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