- Molina Healthcare (Omaha, NE)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service… more
- R1 RCM (Salt Lake City, UT)
- …automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to draft ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and… more
- Centene Corporation (New York, NY)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... **Hours: 8:30am-5pm EST Monday - Friday.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals...analyzing the basis for the appeal + Ensures timely review , processing, and response to appeal in accordance with… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- R1 RCM (Salt Lake City, UT)
- …you will help support clinicians who conduct a comprehensive review of clinical denials and formulate appeals based on clinical documentation, ... position. **Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor...outcomes. + Assess the viability of cases for external review or escalation, as well as make final determinations… more
- Northwell Health (Melville, NY)
- …plus specialized certifications as needed. Preferred Skills 3-5 years experience in Utilization Review , Case Management, and Clinical Appeals . 3-5 years of ... stay. Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately… more
- US Tech Solutions (Columbia, SC)
- …services, and appeals . Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and ... + 80% May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a… more
- Centene Corporation (Harrisburg, PA)
- …+ Provide coding/ clinical decisions on first time claims, adjustments and appeals in accordance with correct coding guidelines and Centene payment policies. + ... claim reviews to ensure compliance with coding guidelines through a comprehensive review and analysis of claims, medical records, claims history, state regulations,… more
- LifePoint Health (Hickory, NC)
- *_Registered Nurse (RN), Clinical Case Manager PRN_* *_PRN/Days_* * * * * *Schedule:* Monday-Friday 7:30a-4:00p/8:00a-4:30p * *Your experience matters* Frye ... and harassment in employment." **Job:** **Nursing* **Organization:** ** **Title:** *Registered Nurse (RN), Clinical Case Manager PRN* **Location:** *NC-Hickory*… more
- LifePoint Health (Hickory, NC)
- *_Registered Nurse (RN), Clinical Case Manager_* *_Fulltime: Days_* ** ** *Schedule:* Monday-Friday 7:30a-4:00p/8:00a-4:30p * *Your experience matters* Frye ... harassment in employment. **Job:** **Nursing* **Organization:** ** **Title:** *Registered Nurse (RN), Clinical Case Manager* **Location:** *NC-Hickory*… more
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