- Humana (Juneau, AK)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...action. Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in… more
- CVS Health (Santa Fe, NM)
- …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 ... in state of residence. + 3+ years clinical experience. **Preferred Qualifications** + Appeals , Managed Care, or Utilization Review experience. + Proficiency with… more
- McLaren Health Care (Grand Blanc, MI)
- …maintenance of continuing education requirements Preferred: + Experience in utilization management /case management /clinical documentation. + Certification ... patient care team. Educates health team colleagues about complex clinical appeals /denials, utilization review, including role, responsibilities tools, and… more
- CareFirst (Baltimore, MD)
- …(KSAs)** + Demonstrated knowledge of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate implementation...clinical experience OR 5 years experience in Medical Review, Utilization Management or Case Management … more
- LA Care Health Plan (Los Angeles, CA)
- …least 8 years of clinical appeals and grievances experience in a managed care, utilization management and/or case management setting, At least 2 years in ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department:...position will mentor, coach, and may provide feedback to management on performance of staff. Ensure team effectiveness and… more
- Providence (Torrance, CA)
- … Management Recovery Advocate (CMRA) is responsible for providing overall management and communication of clinically-based appeals between Providence Health ... + Associate's Degree Nursing. + Upon hire: California Registered Nurse License. + 2 years Direct patient care experience...management certification. + Experience working with denials and appeals in/for an acute care setting. + Experience in… more
- Centene Corporation (Trenton, NJ)
- …Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- McLaren Health Care (Mount Pleasant, MI)
- …education sessions to maintain competency and knowledge of regulations in denials, utilization management , care management , clinical documentation, and ... . Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews… more
- CommonSpirit Health (Centennial, CO)
- …you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all care sites ... required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive experience in utilization review, preferred.… more
- Nuvance Health (Danbury, CT)
- …in Milliman and InterQual Guidelines required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum ... members of the interdisciplinary care team * Current working knowledge of utilization management , performance improvement and managed care reimbursement. Working… more
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