- Elevance Health (Charlotte, NC)
- ** Nurse Appeals - Litigation & Legal Support** **Location:** North Carolina, candidates must be residents of North Carolina to be considered. **In Office ... will be necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support** is responsible for investigating and processing… more
- Elevance Health (Atlanta, GA)
- ** Nurse Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing ... shift between those hours, including holidays on a rotational basis. The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- Elevance Health (Costa Mesa, CA)
- ** Nurse Appeals RN-Quality of Care** **Location: California-Costa Mesa, Walnut Creek, or Woodland Hills** **Hybrid 1:** This role requires associates to be ... Work Hours:** Monday-Friday, 8:00AM -5:00 PM Pacific Standard Time The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- Elevance Health (Metairie, LA)
- ** Nurse Appeals RN-Quality of Care** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, ... Work Hours:** Monday-Friday, 8:00AM -5:00 PM Eastern Standard Time The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... the safety net required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding ... adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all applicable State and Federal rules and… more
- CVS Health (Columbus, OH)
- …Management (UM) Nurse to join our remote team. **Position Summary** The Appeals Nurse Consultant plays a key role in resolving clinical complaints and ... appeals by reviewing medical records and applying clinical guidelines...+ Administers review and resolution of clinical complaints and appeals . + Interprets data obtained from clinical records to… more
- Penn State Health (Hershey, PA)
- …that prohibit or outlaw discrimination._ **Union:** Non Bargained **Position** Clinical Appeals Nurse - Revenue Integrity Process **Location** US:PA: Hershey ... required. + Currently licensed to practice as a Registered Nurse by state of employment or holds a multistate...Licensure Compact. + Prior experience with denial management and appeals required. + Familiarity with payer guidelines. + Excellent… more
- Cognizant (Washington, DC)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Evolent (Montpelier, VT)
- …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