RN Clinical Appeals Analyst: Medical Necessity Expert
CGS Administrators LLC
CGS Administrators LLC is hiring an Appeals Analyst to join BlueCross BlueShield of South Carolina in Nashville, TN. This role involves researching 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, and clinical experience. The position is full-time with the option to work remotely or on-site, offering comprehensive benefits including health plans and retirement savings. #J-18808-Ljbffr CGS Administrators LLC
- ...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
- ...Southcarolinablues is hiring an Appeals Analyst to join their team in Nashville... ...appeal requests and performing clinical reviews to ensure compliance with medical necessity guidelines. The position offers... ...clinical experience, a valid RN license, and strong analytical...MedicalFull timeRemote work
- ...are currently hiring for an Appeals Analyst to join BlueCross BlueShield... ..., you will provide thorough clinical review or benefit analysis to... ...the requested services meet medical necessity guidelines. Lastly, you will... ...: An active, unrestricted RN license from the United States...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
- ...Vanderbilt University Medical Center in Nashville seeks a Pharmacy Technician to provide medication preparation, patient care, and drug... ...Technician certification. Ideal for those seeking to grow in a clinical environment, this position offers a flexible schedule with a...MedicalFlexible hours
- ...HireRight is looking for a Travel and Expense Analyst to manage travel and expense processes efficiently while ensuring compliance with... ...is based in Nashville, TN, and includes various benefits such as medical, dental, and a generous vacation program. #J-18808-Ljbffr...Medical
- ...Float Pool Nurse to join their dedicated team at TriStar Centennial Medical Center in Nashville, Tennessee. The role involves delivering... ...healthcare journey. The successful candidate will need a current RN license, CPR certification, and a background in cardiac care....Medical
- ...TriStar Skyline Medical Center is seeking a dedicated Medical Surgical/Acute Care Registered Nurse to join our team in Nashville, TN. You will coordinate patient care, collaborate closely with physicians, and support patients and their families through their medical journeys...Medical
- ...Provider to deliver high-quality patient care within our urgent care facility's ancillary services team. The role focuses on both medical and cosmetic aspects of dermatology, with responsibilities that include diagnosing skin conditions, performing skin biopsies, and patient...Medical
- ...Vanderbilt University Medical Center in Nashville, TN is looking for a dedicated Registered Nurse to join its Cancer Clinic team. The role involves planning and implementing patient care, ensuring effective communication with the healthcare team, and evaluating patient...MedicalFull time
- ...Tennessee Oncology is hiring a dedicated RN to provide safe, quality cancer care throughout the treatment process. This role involves administering chemotherapy, collaborating with physicians, and ensuring patient education. The ideal candidate will have a current RN...
- ...Vanderbilt University Medical Center in Nashville, TN, is seeking a Registered Nurse for the Medical Infusion Clinic. The role involves planning and implementing patient care while collaborating with a healthcare team to enhance patient outcomes. Strong candidates should...MedicalFull time
- ...TriStar Skyline Medical Center is seeking a Registered Nurse to coordinate and deliver high-quality, patient-centered care. The RN will work collaboratively with medical providers for pre-operative and post-operative nursing care, while advocating for patients. Responsibilities...Medical
- ...Vanderbilt University Medical Center in Nashville, Tennessee is seeking a Case Manager to coordinate patient care through the continuum of services. The ideal candidate will have a background in nursing and will be responsible for ensuring the right treatment plans for...Medical
- ...Physicians’ Group. The role involves providing clinical and administrative support during clinic hours while assisting medical providers. Key responsibilities include... ...Records system. Candidates should possess a valid RN license for Tennessee and have strong communication...MedicalRemote work
- ...Discover Vanderbilt University Medical Center : Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery... ...of the healthcare team. Has experience in gathering pertinent clinical data that aid in referral, treatment, or other primary care...MedicalTemporary workWork experience placementMonday to FridayFlexible hours
- ...Fertility Providers Alliance in Nashville, TN, is seeking a Sonographer to utilize diagnostic medical equipment for various medical assessments. The position emphasizes patient care, including explaining procedures and maintaining records. The role requires a Registered...Medical
- ...Discover Vanderbilt University Medical Center : Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery... ...of the healthcare team. Has experience in gathering pertinent clinical data that aid in referral, treatment, or other primary care...MedicalTemporary workWork experience placementMonday to FridayFlexible hoursWeekend workDay shift
$47 per hour
...healthcare settings. The Registered Nurse, or RN, is responsible for working with other... .... * The RN should be able to read medical equipment and documents. Pushing carts and... ...related study data to physicians, nurses, and clinical staff · Assess the patient and document...MedicalContract workLocal areaLong distanceFlexible hours$33.12 - $56.77 per hour
...Elevance Health is seeking a Nurse Reviewer I who will perform medical necessity reviews for diagnostic imaging services from a virtual... ...arrangement. The role requires a nursing degree and relevant clinical experience, with an hourly pay range of $33.12 to $56.77. Elevance...MedicalHourly payRemote workFlexible hours- Vanderbilt University Medical Center in Nashville is seeking a Registered Nurse for the Heart Failure Clinic. In this full-time role, you will apply the nursing process to provide patient care, establish care plans, and educate patients and families. The ideal candidate...MedicalFull time
- ...Asct in Nashville, Tennessee is seeking a Sonographer responsible for using diagnostic medical equipment to diagnose various medical conditions. This role involves preparing equipment, explaining procedures to patients, and operating ultrasonic machines to generate diagnostic...Medical
- ...Heritage Medical Associates in Nashville, TN is seeking a Licensed Registered Nurse for professional nursing care within a clinical environment. The role includes assisting physicians, administering... ...have a minimum of one year of RN experience in a medical clinic setting...Medical
$90k - $104.84k
...Pivotal Placement Services is seeking an experienced DRG Coder / Clinical Auditor (RN) for a remote full-time position. This role involves conducting quality audits of inpatient medical records to ensure accurate DRG assignment and compliance with regulations. The ideal...MedicalFull timeRemote work- ...Clinical Appeals Reviewer (Licensed Healthcare Professional)... ...to Registered Nurses (RN), Physical Therapists... ...Responsibilities Reviews medical records/case files,... ...as a subject matter expert. Mentors and/or trains... ...or making medical necessity decisions. Proficiency...MedicalFull timeContract workPart timeFor contractorsWork at officeLocal areaRemote workNight shift
- ...: 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
- ...Heritage Medical Associates in Brentwood, TN is seeking an Audiologist to provide professional audiology care in our Otolaryngology department. The candidate will assess and test for communication and balance disorders and perform various physician-supervised treatments...Medical
- ...Heritage Medical Associates seeks a Medical Assistant to perform clinical, administrative, and clerical duties in Nashville, TN. This position requires collaboration with healthcare providers and delivering high-quality patient care. The role involves patient data collection...Medical
- ...financial, satisfaction, and clinical as the nursing component of the... ...role partners closely with the Medical Director and interdisciplinary... ...based on published research. RN Access Patient Education (Advanced... ...(Advanced): Demonstrates expert knowledge and experience in patient...MedicalTemporary workWork at officeMonday to FridayFlexible hours
$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
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