- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound ... regulatory timeframes.The TeamAs an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a liaison and business expert… more
- Molina Healthcare (Jacksonville, FL)
- …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
- Guidehouse (New York, NY)
- **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** + Performs chart ... of care or observation services based on physician certification + Gathers clinical information to conduct continued stay utilization review activities with payers… more
- Henry Ford Health System (Troy, MI)
- …Grievance department. + Other duties assigned by the Clinical Director, Appeals and Grievance. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse with current ... GENERAL SUMMARY: The Clinical Manager, Provider Appeals supports appeals team members to plan, direct, evaluate, coordinate, and manage the activities… more
- R1 RCM (Boise, ID)
- …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
- CVS Health (Hartford, CT)
- …on-call work. **Position Summary** Responsible for the review and resolution of clinical appeals . Reviews documentation and interprets data obtained from ... active and unrestricted RN licensure in state of residence + 3+ years clinical experience **Preferred Qualifications** + Appeals Experience + Managed Care… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- BronxCare Health System (Bronx, NY)
- …arrive in letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal ... Overview The Appeals Manager is responsible to assist in the...preferred. The Appeal Manager should have experience as a nurse in acute care clinical setting who… more
- City and County of San Francisco (San Francisco, CA)
- …assists with designing and implementing plans for meeting such needs. The Clinical Nurse Specialist performs other related duties as assigned/required. Minimum ... by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- City and County of San Francisco (San Francisco, CA)
- …Nurse (RN) license issued by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a valid Clinical ... centers. Under general medical and nursing direction, you will perform pediatric clinical nursing duties in hospitals, clinics, and community health centers. As a… more
Recent Jobs
-
Exploration Advisor- Sr. Academic Advisor
- University of Utah (Salt Lake City, UT)
-
Production Clerk - Accredo
- The Cigna Group (Orlando, FL)
-
Part-Time Weekend Healthcare Security Officer - Eastern Maine Medical Center
- Securitas Security Services USA, Inc. (Bangor, ME)
-
Licensed Clinical Professional Counselor: Center for Child and Family Traumatic Stress $10,000 Hiring Incentive
- Kennedy Krieger Institute (Baltimore, MD)