...treatment facility located in Flushing, NY is looking for an Clinical Review Nurses.
Type: Contract
Schedule: M-F 8:30am-5:30pm -1 Hour... ...for making appropriate and correct clinical decisions for appeals outcomes within compliance standards.
Responsible for determining...
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Permanent employment
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...Named among "America's 100 Most Trustworthy Companies" by Forbes magazine
Named among "Great Places to Work" by Becker's Hospital Review
~ Career Growth Opportunities
~ Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days...
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Holiday work
Flexible hours
..."150 Great Places to Work in Healthcare" by Becker's Hospital Review and has ranked three years running as "The World's Most Admired... ...plans
*The Akron, OH billing center has multiple openings for Appeals Representatives. These are remote, work-from-home positions*...
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Remote job
Work from home
...magazine
Named among "Great Places to Work" by Becker's Hospital Review
~ Career Growth Opportunities
~ Benefit Eligibility (... ...the invoice can be resubmitted.
Provide coding direction to appeal invoices and/or submit appeals via payer website or fax, as...
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Holiday work
Flexible hours
Job Description:
PURPOSE:
The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or...
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Immediate start
...Clinical Coding Reviewer at R1 RCM in Boise, Idaho, United States Job Description As our Clinical (Coding) Reviewer, you will review and interpret medical records to draft appeals of denied and underpaid claims to ensure appropriate coding of removed or revised diagnosis...
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...work more efficiently. Are you passionate about delivering patient-centered care? Submit your application for Registered Nurse Clinical Reviewer position and spend more time at the bedside with the patient.
BenefitsCorpus Christi Medical Center Bay Area, offers a total...
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Part time
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...Physician Clinical Reviewer-Pulmonology at Evolent Health in Boise, Idaho, United States Job Description Your Future Evolves Here Evolent partners... .... + Provides clinical rationale for standard and expedited appeals. + Ensures documentation of all communications with medical...
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...values and invites you to be a part of that experience.
The Clinical Review and Coding Nurse is responsible to attain procedure and... ...perform and coordinate the clinical component of the provider appeal function including communication of the decision on whether to...
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Work experience placement
Flexible hours
...ability to pay for health care.
The Utilization Review Nurse will be responsible for substantiating medical necessity and clinical appropriateness of services in order to... ...Physician Advisors to manage retrospective appeals and documents according to established policy...
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...Clinical Review Pharmacist at Prime Therapeutics in Boise, Idaho, United States Job Description Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make...
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Local area
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...empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that... ...solutions in the public sector.
Acentra seeks a UM Reviewer & Appeals Coordinator RN (Remote within Virginia) to join our growing...
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Hourly pay
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Local area
...Physician Clinical Reviewer- Rheumatology- REMOTE at Prime Therapeutics in Boise, Idaho, United States Job Description Our work matters. We... ...fax. + Provides clinical rationale for standard and expedited appeals. + Provides assistance and act as a resource to Initial Clinical...
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Internship
...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/or utilization management working on the manage care side.Excellent computer...
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Full time
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Monday to Friday
...opportunity employer.
Description of Duties:
The Clinical Appeals Nurse is responsible for the completion of clinical appeals... ...completion of clinical appeals and state hearings from all states
Review and complete all provider clinical appeals within required...
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Full time
Remote job
Relocation package
Flexible hours
Overview:
At St. Lukes, our dedicated team of Utilization Reviewer RN's are critical in providing exceptional, patient-centered care. We strive to foster an environment that embraces our employees' unique strengths, experiences and perspectives which ultimately drives...
Relocation bonus
Shift work
Day shift
...Manager of Clinical/Coding Appeals & Denials at R1 RCM in Boise, Idaho, United States Job Description As our Manager of Clinical/Coding Appeals & Denials, you will serve as an expert on appeals and denials management. This role will represent client hospitals where claims...
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Temporary work
For contractors
Local area
...Clinical Pharmacist Reviewer- REMOTE at Prime Therapeutics in Boise, Idaho, United States Job Description Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision...
Remote job
...Job Description Description: Soleo Health is seeking a Clinical Review Coordinator to support our Home Infusion Specialty Pharmacy... ...resolve denials by utilizing nationally recognized criteria for appeal submission. Responsibilities include:
Completes prior authorization...
Holiday work
Full time
Remote job
Flexible hours
Monday to Friday
Heard and Smith, LLP
Case Status and Appeals Representative
Heard and Smith, LLP was founded on the principles of compassion, humility and the relentless desire to pursue financial assistance for our clients. Our law firm has been helping the disabled for over 30...
Hourly pay
Holiday work
Immediate start
Remote job
Work from home
Home office
...Duties
WHAT IS THE APPEALS (AP)DIVISION?
A description of the business units can be found at:
Vacancies will be filled in the... ...this position at the full working level.
Performs quality reviews of Appeals cases closed through APS using Appeals Quality Standards...
Full time
Temporary work
Part time
Work experience placement
Local area
Remote job
Relocation
Day shift
...Summary
We are seeking a talented individual for a Nurse Reviewer Appeals and Hearing to coordinate and perform all appeal-related duties... ...Reviews provider appeals and redeterminations using approved clinical and coding guidelines and documents appeal determinations...
Full time
Remote job
Flexible hours
...better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Clinical Review Pharmacist
Job Description
The Clinical Staff Pharmacist is responsible for the processing and documenting of Utilization...
Holiday work
Local area
Visa sponsorship
Work visa
Weekend work
...Network Job Description :
GENERAL OVERVIEW:
This job is responsible for all aspects of clinical appeal activities to include but not limited to, clinical record review, composing comprehensive appeal letters and compiling minimum necessary documentation to...
Full time
Local area
...Clinical Data Reviewer at ICON Strategic Solutions in Boise, Idaho, United States Job Description As a Clinical Date Reviewer you will be joining the world's largest & most comprehensive clinical research organisation, powered by healthcare intelligence. What you will...
...Conduct and investigate member and provider medical necessity appeals
Review prospective, inpatient, and retrospective medical records of... ...and grievances are resolved in a timely manner
Prepare clinical reviews and provides monitoring of cases involving medical decisions...
...ability to work independently researching and reviewing inquiries from members and providers.... ...analyzing, researching, and managing appeal/grievance inventories from members and providers... ...in the organization (e.g. managers, clinical, and support staff).
Excellent...
Full time
Contract work
Work experience placement
...supervision of the Director of Case Management, the Utilization Review Nurse provides a clinical review of cases using medical necessity criteria to... ...when there are potential or actual denials. Facilitates appeals or the delivery of appeal instructions when denials occur...
Permanent employment
Temporary work
...Clinical Review RN
5297 W Copans Rd, Margate, FL 33063, USA
Req #460
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 makers, and general...
...Appeals Specialist I
Remote within WA, ID, OR, and UT
Primary Job Purpose:
Responsible for all activities associated... ...preparation, evaluation of prior determinations, coordination of clinical review if needed, decision making, notification, and completion....
Contract work
Work experience placement
Remote job