Search Results: 241,648 vacancies
...JOB DESCRIPTION
For this position we are seeking a (RN) Registered Nurse who must be licensed in the state you reside.We are looking for a Clinical Nurse Appeals RN to support our SC Health plan (Medicaid and Marketplace). Strong experience with appeals reviews and...
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Remote job
Full time
Work experience placement
Home office
Weekend work
Monday to Friday
...everything for our 28 million members as a clinical professional on our Medical Management/... ...reviews needed to resolve and process appeals by reviewing medical records and clinical... ...Graduate from an Accredited School of Nursing or Bachelors degree in Nursing and 2 4 years...
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Hourly pay
Holiday work
Remote job
Flexible hours
...Part of a multidisciplinary team, responsible for clinical oversight of assigned grievance and
appeal cases. Utilizes clinical judgement in the assessment... ...May serve as a backup to absent Grievance & Appeals Nurse Specialists
Attends meetings as needed including but...
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Permanent employment
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Join a team of dynamic, results oriented professionals!
Named among "The World's Most Admired Companies" by Fortune Magazine
Named among "America's 100 Most Trustworthy Companies" by Forbes magazine
Named among "Great Places to Work" by Becker's Hospital...
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Flexible hours
...Washington, D.C., Puerto Rico and the United Kingdom.
The Atlantic Region CBO is seeking a dynamic and talented Clinical Documentation Improvement (CDI) Nurse.
The Clinical Documentation Improvement (CDI) Nurse provides clinically based concurrent and...
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Local area
...time off
~ Eight Paid Holidays per year
~ Quarterly incentive plans
*The Akron, OH billing center has multiple openings for Appeals Representatives. These are remote, work-from-home positions*
JOB DESCRIPTION OVERVIEW:
~ The Denials & Appeals...
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Remote job
Work from home
...appropriate.
Provide correction suggestions to other departments so the invoice can be resubmitted.
Provide coding direction to appeal invoices and/or submit appeals via payer website or fax, as directed.
Complete reconsideration letters as needed.
Complete...
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Holiday work
Flexible hours
...investigate member and provider medical necessity appeals
Review prospective, inpatient, and... ...resolved in a timely manner
Prepare clinical reviews and provides monitoring of cases... ...RN license preferred
AS/BS in Nursing
The posted pay scale represents the...
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Vice President Clinical Service - Utilization Management & Appeals
Oregon, Washington, Idaho, Utah
Primary Job Purpose
The Vice President Clinical Services is a member of the Health Services Organization (HSO) leadership team focused on enabling members to achieve...
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Holiday work
Work from home
...Appeal Experience REQUIRED
RESPONSIBLE FOR:
Detailed review, analysis and extraction of clinical information from patient medical records and drafting of
effective narratives... ...Graduate from an accredited School of Nursing
MINIMUM EXPERIENCE REQUIRED:...
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...GENERAL OVERVIEW:
This job is responsible for all aspects of clinical appeal activities to include but not limited to, clinical record... ...QUALIFICATIONS:
Minimum
High School/GED
3 years in Nursing
RN License - PA
Proficiency in Microsoft Office (Word,...
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Full time
Local area
...Summary of Position
We are seeking a talented Grievance & Appeals Specialist who will be responsible for responding to written/verbal... ...to facilitate the accurate administration of benefits and clinical policy; and ensure compliance of the appeal and grievance process...
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Work experience placement
...spent on the particular responsibility - High to Low
1.
Manages workflow for Humana PPI Audits, RAC Audits, or Outpatient Appeals and communicates daily with Sr. Director/Manager on trends identified
2.
Responds to queries within 72hrs, appropriately documents...
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...Job Description
Division/Unit: Appeals Division
Position Title: Appeals Paralegal
Civil Service Title: Community Associate
Salary Range: $49,000 - $51,984
Job Description:
The New York County District Attorney's Office anticipates openings beginning in...
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Summer work
Shift work
Monday to Friday
...Description Description: Position Name: Behavioral Health Appeals Nurse
Location: Must Reside in Indiana, designated remote work... .../grievances/quality of care issues and is a resource for clinical and non-clinical team members in expediting the resolution of...
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Saturday
...Translate/Traducir:
Clinical Appeals Auditor
Start Date: May 1, 2024•
Contract to Hire •
Columbia,... ...you’ll need:
Minimum Degree: Bachelor’s degree or higher in nursing; current RN licensure
Minimum Years of Experience: 5+...
Permanent employment
Contract work
Local area
Remote job
Flexible hours
...the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene... ...and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from...
Hourly pay
Holiday work
Remote job
Flexible hours
...Job Summary:
The Clinical Appeals Nurse is responsible for the completion of clinical appeals and state hearings from all states.
Essential Functions:
Responsible for the completion of clinical appeals and state hearings from all states
Review and complete...
Remote job
Full time
oPerforms daily quality assessments for all function areas of the Appeals and Grievances Department to assure the integrity of processes - for all lines of business.
oReviews include assessments of the decision-making process through the life of the appeal and assuring...
...ICD coding. Responsible for analyzing, researching, and managing appeal/grievance inventories from members and providers. Respond to... ...communicate with multiple levels in the organization (e.g. managers, clinical, and support staff).
Excellent organizational skills...
Full time
Contract work
Work experience placement
