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
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- ...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
- ...are currently hiring for an Appeals Analyst at BlueCross BlueShield of South... ...requests, conduct thorough clinical review or benefit analysis... ...if requested services meet medical necessity guidelines, and document decisions... ...: an active, unrestricted RN license from the United...MedicalFull timeFor contractorsCurrently hiringWork at officeLocal areaWork from homeMonday to Friday
- ...of South Carolina is hiring an Appeals Analyst to research and analyze complex... ...position involves conducting thorough clinical reviews to ensure compliance with medical necessity guidelines. The successful... ...Associate's degree, an active RN license, and significant...MedicalRemote jobFull timeWork at officeWork from home
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- ...Market Appeals Specialist Responsibilities BH Shared... .... The ability to apply clinical acumen in a behavioral... ...compensation ~ Excellent medical, dental, vision and... ...Master's preferred ~ RN license or master's level... ...of medical necessity criteria application for...MedicalWork at officeLocal area
$20.02 - $25.78 per hour
...Cycle Management team focuses on a series of clinical and administrative processes that... ...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 areaImmediate startRemote workFlexible hours- ...that have been deferred for medical necessity review. Ensures compliance with... ...Work Experience: 5 years clinical and utilization review to include... ...and Certificates: Active RN licensure in state hired, OR,... ...expertise in Medicare claim reviews (Appeals, Utilization Review, Part A,...MedicalFull timeFor contractorsWork experience placementWork at officeLocal areaRemote workMonday to Friday
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- ...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
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$47 per hour
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- ...a role where leadership, mentorship, and clinical excellence come together with purpose, this... ...The NP will report directly to the State Medical Director and serve as the primary... ...resource, supervisor, and partner to the RN field team. Key Responsibilities Remote Clinical...MedicalFull timeTemporary workRemote work
- ...: GynOnc Infusion Building: Centennial Medical Center Cost Center: 714 General Information... ...Expanse Scheduling requirements: M-F clinic, no weekend and no major holidays... ...experience of staff, schedule options, etc. #TB_RN #ZRHC Why TalentBurst? At...MedicalPermanent employmentContract work
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...Join to apply for the Appeals and Letters Coordinator Remote role at Optum 1 day ago... ...and documented. May confer with medical directors, Health Plan Manager(s), Inpatient... ...letters, NOMNC letters, AOR forms, and clinical information Act as a point person for...MedicalHourly payMinimum wageFull timeContract workPart timeWork experience placementWork at officeLocal areaRemote workShift workWeekend work$79.2k - $129.6k
Overview RN - Oncology Clinical Reviews (JR192475) Hybrid 1 : This role requires associates to be in‑office 1 - 2 days per week, fostering collaboration... ...unless accommodation is granted as required by law. The Medical Underwriter Sr (Clinical Review) is responsible for...MedicalWork at officeLocal area2 days per week1 day per week$25k
...Clinical Care Nurse (RN) The Clinical Care Nurse (RN) is a clinic-based nursing role focused on improving patient outcomes. You will support... ...on preventive care, chronic disease management, and medication management. Conduct post-discharge outreach to assess understanding...MedicalFull timeTemporary workWork at officeMonday to Friday$25k
...Become a part of our caring community The Clinical Care Nurse (RN) is a clinic-based nursing role focused on improving patient outcomes.... ...education on preventive care, chronic disease management, and medication management. Conduct post-discharge outreach to assess...MedicalFull timeTemporary workApprenticeshipWork at officeMonday to Friday- ...Medical Data Systems Inc. is seeking a detail‑oriented and motivated Insurance Appeals Specialist to join our insurance support and billing team. The ideal candidate will demonstrate professionalism, independence, and a strong understanding of insurance processes while...MedicalFull timeWork at office
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$34.05 - $51.1 per hour
...Responsibilities: Provide high-quality clinical services within scope of practice and... ...Ensure patient/client eligibility and medical necessity for services as defined by payer and agency... ...Qualifications: ~ Current and unrestricted RN licensure in the state of practice ~...MedicalHourly payMinimum wageFull timeWork experience placementLocal area$28.94 - $51.63 per hour
...Responsibilities: Provide high-quality clinical services within scope of practice and... ...Ensure patient/client eligibility and medical necessity for services as defined by payer and agency... ...Qualifications: ~ Current and unrestricted RN licensure in the state of practice ~...MedicalHourly payMinimum wageFull timeWork experience placementLocal area$33 - $45 per hour
...Primary Responsibilities Provide high-quality clinical services within scope of practice and... ...Ensure patient/client eligibility and medical necessity for services as defined by payer and... ...Qualifications Current and unrestricted RN licensure in the state of practice Current...MedicalHourly payMinimum wageFull timeWork experience placementLocal area- ...talented healthcare professionals in clinical and non-clinical positions... ...Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals,... ...Summary: As the Utilization Review RN, you would be responsible for... ...in order to determine medical necessity of continued stay according to...MedicalPrivate practiceMonday to Friday
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