RN Appeals Analyst - Clinical Appeals & Medical Necessity
CGS Administrators
CGS Administrators is seeking an Appeals Analyst in Nashville, TN. The role involves researching complex appeal requests, documenting decisions, and providing thorough clinical review to ensure compliance with medical necessity guidelines. The ideal candidate will have a nursing degree and clinical experience, with strong analytical and communication skills. This position offers a full-time schedule with benefits. #J-18808-Ljbffr CGS Administrators
- CGS Administrators LLC is hiring an Appeals Analyst to join BlueCross BlueShield of... ...complex appeal requests, conducting clinical reviews, and ensuring compliance with medical necessity guidelines. The ideal candidate will have an RN license, a degree in a related field...MedicalFull timeRemote work
- ...part of BlueCross BlueShield, is hiring an Appeals Analyst. This role involves researching complex appeal requests and performing clinical reviews. The job is full-time, Monday... ...experience in clinical settings, and an active RN license. Benefits include 401(k) match,...MedicalFull timeRemote workMonday to Friday
- ...are currently hiring for an Appeals Analyst to join BlueCross BlueShield... ...appeal requests—provide thorough clinical review or benefit analysis... ...the requested services meet medical necessity guidelines, and document... ...Certificate An active, unrestricted RN license from the United...MedicalFull timeFor contractorsCurrently hiringWork at officeLocal areaMonday to Friday
- Healthfirst is seeking an Appeals & Grievances Clinical Specialist to handle the end-to-end process for member and provider clinical appeals and grievances... ...and regulatory expectations. The position requires an RN and offers collaboration across departments to manage large...Suggested
$83.1k - $120.36k
Position Summary: The Appeals & Grievances Clinical Specialist is responsible for receiving, investigating... ...policy Enters data into appropriate medical management services Collaborates with... ...as assigned Minimum Qualifications RN Preferred Qualifications Experience...MedicalTemporary workWork experience placement$20.02 - $25.78 per hour
...Cycle Management team focuses on a series of clinical and administrative processes that healthcare... ...is zero. Responsibilities Submitting medical documentation/billing data to insurance providers Researching and appealing denied and rejected claims Preparing, reviewing...MedicalHourly payTemporary workWork experience placementLocal areaRemote workFlexible hours- Memorial Physician Practices in Brentwood, TN, is seeking a Clinical Adoption Analyst to provide training and support for the athena clinical... ...will have a high school diploma and a year of experience in a medical office setting, helping to empower staff to deliver better...MedicalRemote jobWork at office
- ...community members to positively impact our mission of making communities healthier. More about our team The Clinical Adoption Analyst educates providers and others in Medical Group Services practices on documentation within the EHR system, focusing on supporting workflow and...MedicalRemote jobFull timeTemporary workPart timeWork at officeLocal area
- ...running relevant reports and documenting appeal results. The individual will manage post-... ...excellent communication skills, a solid clinical background, and proficiency in Microsoft... ...competitive compensation package, including medical and dental plans, a 401(k) matching plan,...Medical
- ...The Business Analyst, Pricing and Underwriting , is responsible... ...with Underwriting, Finance, Clinical, and Account Management teams... ...operations by: Managing pricing appeals, coordinating with Maxor... ...including a $850 individual annual medical deductible and $25 office...MedicalFull timeTemporary workWork at officeRemote workWork from home
- ...running relevant reports and documenting appeal results in MS4 and MIDAS, ensuring proper... ...authorization disputes and "take-backs" related to clinical authorization and closed chart denials.... ...~ Competitive compensation ~ Excellent medical, dental, vision and prescription drug...MedicalWork experience placementLocal area
- ...excellent care patients deserve? At TriStar Skyline Medical Center, we support our colleagues in their positions. Join our Team as a Clinical Nurse Coordinator on our Rehab Unit and... ...may vary by location. Inpatient Rehab RN Clinical Nurse Coordinator - Nights Job...MedicalHourly payFull timeTemporary workPart timeFlexible hoursShift workNight shift
$27 per hour
...opening for a Reimbursement Solutions Analyst. What Clinical Operations contributes to Cardinal... ...advocacy identification for procedures and medications scheduled to be given in the... ...for prior authorization and medical necessity Extensive patient education/counseling...MedicalTemporary workWork at officeLocal areaImmediate startRemote workFlexible hours- ...to deliver excellent care patients deserve? At TriStar Skyline Medical Center we support our colleagues in their positions. Join our Team... ...is important to you, we encourage you to apply for our RN opening. Our team will promptly review your application. Highly...MedicalFull timeTemporary workPart timeFlexible hours
- ...Maximus is seeking a Clinical Reviewer, RN/LPN to support the Tennessee Katie Beckett Program. You will review clinical documentation, medical records, assessments, and supporting information to help determine program eligibility for children with disabilities or complex...MedicalContract workRemote work
- ...of the healthcare team. Has experience in gathering pertinent clinical data that aid in referral, treatment, or other primary care pathways... ...and is committed to the principles of equal opportunity. EOE/Vets/Disabled. #J-18808-Ljbffr Vanderbilt University Medical CenterMedicalTemporary workWork experience placementFlexible hours
- UHS is looking for an experienced Market Appeals Specialist to support utilization management... ...candidate will have a Bachelor's degree, RN License or Master's level qualification,... ...package, including excellent medical, dental, and vision benefits. #J-18808-Ljbffr...MedicalRemote job
$68.97k - $113.31k
...The RN Clinical Consultant serves as a clinical resource for the investigation and assessment of medical information regarding disability by providing comprehensive medical reviews and analysis of long‑term and short‑term disability claims. The Clinical Consultant identifies...MedicalFull timeTemporary workWork at officeVisa sponsorshipWork visaFlexible hours- Medical Data Systems Inc. in Tennessee is looking for a detail-oriented Insurance Appeals Specialist to join their billing team. The ideal candidate will have 3-5 years of experience in healthcare, strong communication skills, and knowledge of insurance processes. Responsibilities...MedicalFull time
- Clinical Decision Unit RN Join us as a Clinical Decision Unit RN at TriStar Skyline Medical Center. A sign‑on bonus is available for qualified RN candidates. Benefits Comprehensive medical coverage with low or no copay for common services, prescription drugs, behavioral...MedicalFull timePart timeRelocation packageFlexible hours
- A leading healthcare facility in Nashville seeks a Clinical Decision Unit RN to provide and coordinate patient care. This role involves collaborating... ...environment for professional development and great employee benefits. #J-18808-Ljbffr TriStar Skyline Medical CenterMedicalRelocation package
$34.42 - $67.6 per hour
Join to apply for the Appeals and Letters Coordinator Remote role at Optum 1 day ago Be... ...performed and documented. May confer with medical directors, Health Plan Manager(s),... ...letters, NOMNC letters, AOR forms, and clinical information Act as a point person for internal...MedicalRemote jobHourly payMinimum wageFull timeContract workPart timeWork experience placementWork at officeLocal areaShift workWeekend work- Maximus is hiring a Clinical Reviewer, RN/LPN to support Tennessee Katie Beckett Program. You will review medical records, assessments, and supporting information to determine eligibility for children with disabilities or complex medical needs. This is a remote position...MedicalRemote job
- ...re transforming care delivery, advancing clinical outcomes, and empowering our nursing teams... ...What qualifications you will need: ~(RN) Registered Nurse ~ Bachelors Degree preferred... ...Benefits TriStar Summit Medical Center, offers a total rewards package that...MedicalTemporary workFlexible hours
- ...chains to keep you fully equipped. Ongoing clinical education to improve your skills. As a... ...within 6 months of employment start date ~(RN) Registered Nurse ~ Associate Degree... ...include: Comprehensive benefits for medical, prescription drug, dental, vision,...MedicalHourly payTemporary workFlexible hoursShift work
- ...As a Clinical Nurse Coordinator ER, your voice to influence patient care is valued and empowered... ...6 months of employment start date ~(RN) Registered Nurse ~ Associate Degree... ...Benefits TriStar Southern Hills Medical Center, offers a total rewards package that...MedicalHourly payTemporary workFlexible hoursShift work
- ...As a Clinical Nurse Coordinator, your voice to influence patient care is valued and empowered... ...Benefits TriStar Southern Hills Medical Center, offers a total rewards package that... ...Erica Rossitto, MBA/HCM, BSN, RN, NEA-BC Senior Vice President and Chief...MedicalHourly payTemporary workFlexible hoursShift work
- ...TriStar Southern Hills Medical Center is committed to investing in the latest technology... ...centered care? Submit your application for Clinical Nurse Coordinator position and spend more... ...healthier tomorrow."- Jane Englebright, PhD, RN CENP, FAAN Senior Vice President and...MedicalHourly payFull timeTemporary workPart timeFlexible hoursShift work
- ...us! Job Summary and Qualifications The Clinical Nurse Coordinator (CNC) ensures and delivers... ..., or Registered Nurse Diploma ~2 Years of L&D RN experience Required Benefits TriStar Centennial Medical Center, offers a total rewards package that supports...MedicalHourly payTemporary workFlexible hoursShift work
$34.22 - $48.38 per hour
...Neurosciences and Otolaryngology/Head & Neck Surgery (ENT) Unit at UNC Medical Center in Chapel Hill, NC. This is a 36 hour/week position... ...unique communities we serve. Summary: Provides competent clinical nursing care consistent with professional standards. Reporting...MedicalHourly payFull timeSummer workRelocation packageFlexible hoursNight shiftWeekend work
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