- Molina Healthcare (Salt Lake City, UT)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal appeals clinical processes - ensuring that ... to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- MVP Health Care (Tarrytown, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join #TeamMVP. If you have a ... passion for patient-centered advocacy, clinical precision and regulatory compliance this is an opportunity...UM platforms. + Familiarity with CMS regulations and appeals processes. + Ability to work independently and manage… more
- Centene Corporation (Salem, OR)
- …analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters ... for member and provider clinical appeals and ensure letters are compliant...assigned + Complies with all policies and standards **Education/Experience:** RN with 4+ years of clinical nursing… more
- Trinity Health (Langhorne, PA)
- …experienced Registered Nurse to join our team in Utilization Review! The UM Registered Nurse is responsible for the coordinating and facilitating all ... aspects of reimbursement as related to the clinical review and level of care. Management of all...and level of care. Management of all review and appeals utilizing a modified approach based on specific needs… more
- CVS Health (Atlanta, GA)
- …with heart, each and every day. **Position Summary** CVS Aetna is seeking a dedicated ** Appeals Nurse Consultant** to join our remote team. In this role, you ... critical role in ensuring fair and accurate resolution of clinical appeals by applying sound clinical...UM (includes expedited), MPO, Coding, or Behavioral Health appeals . + This is a full-time telework position with… more
- HCA Healthcare (Gainesville, FL)
- …that invests in you as a Inpatient Authorization Review Services Behavioral Health Registered Nurse ( RN ) or Licensed Mental Health Counselor (LMHC) ... the account being denied by the payor that require clinical expertise. Communicates with third party payors to resolve...care contracting, experienced preferred. + Currently licensed as a registered nurse ( RN ) in the… more
- Swedish Health Services (Seattle, WA)
- …Upon hire: Washington Registered Nurse License + 3 years Registered nursing experience in the clinical setting. **Preferred Qualifications:** + Upon ... **Description** **Utilization Review RN @ Swedish Medical Center** **Part time 0.7...really matters - our patients.** The Utilization Review (UR) Nurse has a strong clinical background blended… more
- Saint Francis Health System (OK)
- …in various levels of care and receipt of necessary services. The Utilization Management ( UM ) Registered Nurse will communicate with providers the details of ... Nursing. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum 2 years of… more
- Molina Healthcare (OH)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (NM)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying that services are… more
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