- CVS Health (Lansing, MI)
- …each and every day. **Position Summary** CVS Aetna is seeking a dedicated ** Appeals Nurse Consultant ** to join our remote team. In this role, you will ... role in ensuring fair and accurate resolution of clinical appeals by applying sound clinical judgment and regulatory knowledge....Occasional weekend and holiday on-call coverage may be required. ** Remote Work Expectations** + This is a 100% … more
- TEKsystems (Orlando, FL)
- …ERISA and state mandates. + Provide insight to management on consultant quality, availability, and compliance with policies/procedures. + Promote efficient ... $31.50/hr | LPN: $29/hr Utilization Management (2 Openings) Responsibilities: + Review appeals and all types of Prior Authorizations. + Conduct Admissions reviews… more
- State of Colorado (Pueblo, CO)
- Nurse I - RN Critical Incident/Occurrence Reporter-CMHHIP-Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5147450) Apply Nurse I - ... + Description + Benefits + Questions Department Information Registered Nurse I-Full Time CMHHIP This position has a residency...context both for this position's assigned workload, and as consultant to the Occurrence Team overall. + Using the… more
- City and County of San Francisco (San Francisco, CA)
- …Independent Medical Evaluators) on complex cases. 12. Works collaboratively with the Occupational Nurse Consultant , Nurse Manager, and/or Nurse Case ... to review complex claims and establish medical protocols. 13. Advises the Occupational Nurse Manager and/or Consultant on issues related to medical clinic… more
- Centene Corporation (Jefferson City, MO)
- …Develop and maintain the audit process and tools related to: authorizations, appeals , quality events, and case management in CCMS; interrater reliability related to ... compliance with the auditing process + Act as a consultant related to system auditing to others in the...+ Complies with all policies and standards POSITION IS REMOTE BUT CANDIDATE MUST RESIDE IN MISSOURI **Ideal candidate… more