- Molina Healthcare (Fort Worth, TX)
- …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 they...with internet connectivity of high speed required **Job Summary** Clinical Appeals is responsible for making appropriate… more
- Evolent (Austin, TX)
- …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... culture. **What You'll Be Doing:** Job Description The Specialty Appeals Team offers candidates the opportunity to make a...be able to exercise independent and sound judgment in clinical decision making. - **Preferred** + Able to navigate… more
- CenterWell (Austin, TX)
- …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 (Austin, TX)
- …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
- Molina Healthcare (San Antonio, TX)
- …resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical ... **JOB DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate… more
- Select Medical (Dallas, TX)
- …A joint venture with Select Medical & Baylor Scott & White Health Dallas, TX ** Clinical Liaison (RN, OT, PT, or SLP)** **Full-Time, Monday through Friday 8am - 5pm** ... **Competitive base salary with monthly bonuses!** Clinical Liaisons are advocates who educate and guide patients toward the next level of care, while building… more
- Houston Methodist (Sugar Land, TX)
- …management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of care for ... **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -...care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge… more
- Molina Healthcare (Austin, TX)
- …national, state, and local laws and regulatory requirements affecting the medical and clinical staff. MD licenses required for the following states: WA, FL, MI, MS, ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
- CVS Health (Austin, TX)
- …in accordance with contract. Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) ... to incoming correspondence and internal referrals. Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management.… more