- St. Luke's University Health Network (Allentown, PA)
- …communities we serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- Centene Corporation (Sacramento, CA)
- …State Licensure required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... a fresh perspective on workplace flexibility. This position requires RN California Licensure and for candidates to have a... requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent… more
- VNS Health (Manhattan, NY)
- …You Will Do + Responsible for direct oversight and the day to day management of clinical appeals review processes within Appeals & Grievances Department. ... Health Plans is seeking a dedicated Manager, Grievance and Appeals ( RN )to lead the daily operations of...quality of care concerns and any other inquires requiring clinical review for medical necessity, appropriateness of… more
- R1 RCM (Detroit, MI)
- …automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to draft ... will experience working as a Clinical Coding Appeals Nurse :** + Review and...external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + An active CCS,… more
- ManpowerGroup (Columbia, SC)
- …to join their team. As an Analyst, Appeals , you will be part of the clinical review department supporting the appeals team. The ideal candidate will have ... including pre-pay and post-payment review appeal requests. + Provide thorough clinical review or benefit analysis to determine if the requested services… more
- Centene Corporation (Topeka, KS)
- …that all appeal letters generated comply with both State and NCQA requirements. + Review clinical information for all appeals utilizing nationally recognized ... analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters… more
- CDPHP (Albany, NY)
- …requirements. Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render ... you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering...review , and making recommendations for change. QUALIFICATIONS: + Registered Nurse , Physician Assistant or Nurse… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …and Medicaid Services (CMS) and other sources. + Liaise with Utilization Management and Clinical Appeals Departments to regularly review data from same ... Registered Nurse , Physician's Assistant, or Nurse Practitioner with five (5) years' clinical ...of the following: pre-service review , post services review , and/or clinical appeals . (Required)… more
- Molina Healthcare (Austin, TX)
- … decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print...RN license. 07 Do you possess an active RN license issued by an Enhanced Nurse Licensure ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4762850) Apply CDOC Registered Nurse ( Nurse I) Salary $7,442.00 Monthly Location Statewide,… more