- R1 RCM (Salt Lake City, UT)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Nurse ** , you will help our hospital clients by ... production-driven position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical records and… more
- R1 RCM (Chicago, IL)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid… more
- Elevance Health (Rancho Cordova, CA)
- ** Nurse Appeals - Licensed RN Nurse ** **Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live in the state of ... locations. **Shift:** Monday to Friday from 8:00-5:00 pm PT The ** Nurse Appeals ** is responsible for investigating and processing medical necessity appeals… more
- University of Washington (Seattle, WA)
- …MEDICINE'S PATIENT FINANCIAL SERVICES Department** has an outstanding opportunity for a **CLINICAL APPEALS AND DISPUTES NURSE ** **Work Schedule** + 100% FTE + ... a timely manner + Review clinical denials and initiate appeals process + Conduct medical necessity reviews, based on...**REQUIREMENTS** + Active licensure to practice as a Registered Nurse in Washington State + Bachelor's degree in Nursing… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct… more
- CVS Health (Hartford, CT)
- …**Position Summary** Responsible for the review and resolution of clinical appeals . Reviews documentation and interprets data obtained from clinical records to ... as required. This position may support UM, MPO, Coding, or Behavioral Health appeals . **Required Qualifications** * Must have active and unrestricted RN licensure in… more
- Genesis Healthcare (Philadelphia, PA)
- …guidance for appeal requests at all levels.Maintains tracking records of appeals management activities in accordance with department policiesPerforms other duties as ... requested.Qualifications: Registered Nurse .Significant experience in the Healthcare Industry.Knowledge of regulatory requirements for reimbursement and reasons for… more
- Actalent (Rancho Cordova, CA)
- …or as clinically appropriate + Provides referrals to Case Management, Disease Management, Appeals and Grievance and Quality Departments as necessary + Assists in the ... development and implementation of a proactive approach to improve and standardize overall retro claims review for clinical perspectives. Skills: Acute Care, Concurrent Review, Home Health, Long Term care, Health plan, Utilization Review, Utilization… more
- St. Mary's Healthcare (Amsterdam, NY)
- …and audit requests and coordinates attempts to overturn denials by drafting appeals , negotiating with payers, or following up with payer utilization review ... nursing required. Licensure / Certification / Registration: Required Credential(s): * Registered Nurse credentialed from the New York Board of Nursing. Complexity of… more
- ProMedica Health System (Toledo, OH)
- …will be assigned based on teamwork load and competency. **This position is Remote, ideally within 120 miles from Toledo, OH. Interviews will be conducted onsite. Pay ... Range: $16.25 - $46.35 Education: Nursing degree Skills: Familiarity with ICD10 and CPT codes applicable to services rendered Have demonstrated ability to communicate with medical and administrative staff and patients, understanding levels of care. Have strong… more