Average salary: $85,149 /yearly
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...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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...RN - Grievance and Appeals Clinical Reviewer
5297 W Copans Rd, Margate, FL 33063, USA
Req #461
Monday, April 1, 2024
Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare...
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...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
...for the management and communication of denials/appeals received from third party payers, managed care companies... ...will be a liaison and point of contact for clinical denials and appeal inquiries. The Clinical Appeals Nurse will review each case identified/referred for appeal...
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Relief
...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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...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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...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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...Cigna Medicare Part C Appeals Reviewer: Appeals Processing Analyst
We will depend on you... ...research and provide a written detailed clinical summary for the Plan Medical Director.... ...Qualifications
~ Education: Licensed Practical Nurse (LPN) or Registered Nurse (RN)
~3-5...
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...system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of... ...liaison, collaborating with various entities including payers, clinical, financial and/or operational departments.
Duties/Responsibilities...
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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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Shift work
Monday to Friday
Overview:
Under the direction of the Supervisor, the Medicare Appeals Specialist receives, investigates, and responds to formal... ...The Medicare Appeals Specialist is responsible for evaluating clinical criteria within medical records and associated documentation to...
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Local area
...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
...RN Clinical Nurse
Please use Google Chrome or Mozilla Firefox when accessing Candidate Home.
By joining the American Red Cross you... ...You can make a difference by volunteering in a position that appeals to you and allows you to use your unique skills and talents....
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...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...
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Full time
...Grievance and Appeals Coordinator
75 Vanderbilt Ave, Staten Island, NY 10304, USA
Req #660
Monday, April 1, 2024
Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision...
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Hourly pay
...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
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...Appeals and Compliance Specialist
Starting Salary: $84,495 - $101,395
This position reports to the Executive Director and is responsible for managing complaints, informal resolution meetings, mediations, and appeals, ensuring compliance with state and federal laws...
Holiday work
Contract work
Work experience placement
Local area
Flexible hours
...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
...Job Description:
The Grievance and Appeals (G&A) Coordinator is responsible for processing appeals, grievances, complaints, and inquiries received from members, authorized representatives, and regulatory agencies.
The Coordinator is expected to analyze the customer...
...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...
