• Clinical Appeals Nurse RN

    HCA Healthcare (Brentwood, TN)
    **Description** **Introduction** Do you have the career opportunities as a Clinical Appeals Nurse RN you want with your current employer? We have an exciting ... caring group of colleagues. Do you want to work as a Clinical Appeals Nurse RN where your passion for creating positive patient interactions is valued? If… more
    HCA Healthcare (05/14/25)
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  • Appeals Licensed Practical Nurse

    Evolent (Nashville, TN)
    …for the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse 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… more
    Evolent (05/16/25)
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  • Appeals Nurse

    Evolent (Nashville, TN)
    …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
    Evolent (05/10/25)
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  • Coordinator-RAC TPE

    Baptist Memorial (Memphis, TN)
    …Code: 21540 FLSA Status Job Family: FINANCE Job Summary Medicare / Medicaid Appeals Registered Nurse reviews and evaluates medical documentation to support ... Responsibilities + Abstracts pertinent information from the medical record to create appeals for cases denied by governmental payors. + Educates department staff to… more
    Baptist Memorial (04/12/25)
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  • Registered Nurse PRN (2 Days Per Week)…

    Vanderbilt University Medical Center (Nashville, TN)
    …pre-certifications (which can take up to 1 hour for completion) and appeals . Other duties included scheduling imaging, requesting outside records, mailing documents ... of emphasizing negative elements. **Position Qualifications:** **Responsibilities:** **Certifications:** LIC-Registered Nurse - Licensure-Others **Work Experience:** Relevant Work Experience **Experience… more
    Vanderbilt University Medical Center (05/14/25)
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  • Customer Service New Business Operations- Hybrid

    CVS Health (Franklin, TN)
    …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
    CVS Health (05/11/25)
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  • Family Health Advocate - Remote

    Sharecare (Nashville, TN)
    …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
    Sharecare (04/12/25)
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  • UR Clinical Specialist

    Community Health Systems (Franklin, TN)
    …role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate efficient ... and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required + CCM -… more
    Community Health Systems (05/20/25)
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