- Molina Healthcare (Austin, TX)
- …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 appropriate and correct clinical decisions… more
- R1 RCM (Detroit, MI)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help ... remote production-drive position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to… more
- Elevance Health (Tampa, FL)
- ** Nurse Appeals Associate II** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of ... our Elevance Health Pulse Point locations. The ** Nurse Appeals Associate II is** responsible for...appeals or managed care and minimum of 1-year clinical experience; or any combination of education and experience,… 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. **ESSENTIAL FUNCTIONS:**...In Lieu of Education. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon… more
- Elevance Health (Roanoke, VA)
- …clinicians and business leaders passionate about transforming American healthcare delivery. ** Nurse Appeals Associate** **Location:** This position will work a ... member of the Elevance Health family of brands, offering clinical programs and primary care options for seniors. We...Must be able to rotate on mandatory holidays. The ** Nurse Appeals Associate** is responsible for supporting… more
- R1 RCM (Detroit, MI)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Supervisor** , you will help support clinicians ... position. **Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor...additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay… more
- R1 RCM (Salt Lake City, UT)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Supervisor** , you will support ... guidelines. **Here's what you will experience working as a Clinical Coding Appeals Supervisor:** + Track daily...on a routine basis. **Required Skills:** + Active Registered Nurse license + Active AHIMA or AAPC Coding Certification… more
- Centene Corporation (Sacramento, CA)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... to work M-F 8-5 PST Hours. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals...management processes preferred. **License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required or + LVN -… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage ... appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and reporting… more
- CDPHP (Albany, NY)
- …share these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and ... Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations… more