- Evolent (Jefferson City, MO)
- …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
- BJC HealthCare (St. Louis, MO)
- …experience) **Additional Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist with infusion appeals for both government ... be handling clinical denials and sending them to a nurse to review and appeal and then they will...clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be able to multi-task and maintain… more
- Children's Mercy Kansas City (Kansas City, MO)
- …utilizing InterQual and/or MCG screening guidelines, and clinical denials/ appeals oversight. Participates in department and hospital performance improvement ... One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire + One...One of the following: Licensed RN - Kansas, Registered Nurse Multistate License Kansas required upon hire + RN… more
- SSM Health (MO)
- …all assigned government audit denials and determining appropriate follow-up actions. Appeals denials which are found to be unsubstantiated through review of ... degree, or equivalent combination of experience and education + Registered Nurse preferred EXPERIENCE + Three years' experience PHYSICAL REQUIREMENTS + Frequent… more