- Cognizant (Lincoln, NE)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and… 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 ... (A&G) & General Operations ( Clinical ) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals & Grievances… 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 ...High School Diploma or GED **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact… more
- Penn State Health (Hershey, PA)
- …executive orders that prohibit or outlaw discrimination._ **Union:** Non Bargained **Position** Clinical Appeals Nurse - Revenue Integrity Process ... + Bachelor's degree in Nursing required. + Currently licensed to practice as a Registered Nurse by state of employment or holds a multistate RN license… more
- Elevance Health (Atlanta, GA)
- ** Nurse Appeals ** **Location:** This role enables associates...or BS in Nursing preferred. + 3 years of clinical experience as a Registered Nurse ... 8-hour shift between those hours, including holidays on a rotational basis. The ** Nurse Appeals ** is responsible for investigating and processing and medical… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate implementation of the clinical appeal process for ... and serves as a resource for associates within the Clinical Appeals and Analysis unit. We are...team-based performance as needed. **Licenses/Certifications** : + RN - Registered Nurse - State Licensure And/or Compact… more
- TEKsystems (San Bernardino, CA)
- Description We are seeking a dedicated Clinical Appeals Nurse to join our Revenue Cycle Management team. The ideal candidate will be responsible for managing ... support appeals , and following up on submitted appeals . The Clinical Appeals Specialist...with a team of Licensed Vocational Nurses (LVNs) and Registered Nurses (RNs) to ensure comprehensive and accurate appeal… more
- Centene Corporation (Jefferson City, MO)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... preferred. Knowledge of utilization management processes preferred. **License/Certification:** RN - Registered Nurse - State Licensure and/or Compact State… more
- Centene Corporation (Trenton, NJ)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... within the Eastern Standard Time Zone.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals...Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview: ;** The Clinical Appeals Reviewer is responsible for processing appeals and ensuring all milestones are met in compliance with regulatory ... preferably within a managed care organization **Licensure:** + Current and unrestricted Registered Nurse (RN) licensure or compact state licensure **Skills &… more
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