- 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 ... **Shift:** Monday to Friday from 8:00-5:00 pm PT The ** Nurse Appeals ** is responsible for investigating and...which would provide an equivalent background. Current active unrestricted RN license to practice as a health professional within… more
- 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 ... **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review...at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position,… 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 ... what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical...external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + **Active AHIMA or… more
- LA Care Health Plan (Los Angeles, CA)
- …The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse ( RN ) II provides direct assistance to member's with ... Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category:...agencies. Good working knowledge of regulatory requirements/standards. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- University of Washington (Seattle, WA)
- …changes impacting revenue cycle **REQUIREMENTS** + Active licensure to practice as a Registered Nurse in Washington State + Bachelor's degree in Nursing + ... MEDICINE'S PATIENT FINANCIAL SERVICES Department** has an outstanding opportunity for a **CLINICAL APPEALS AND DISPUTES NURSE ** **Work Schedule** + 100% FTE +… more
- St. Mary's Healthcare (Amsterdam, NY)
- …of nursing required. Licensure / Certification / Registration: Required Credential(s): * Registered Nurse credentialed from the New York Board of Nursing. ... and audit requests and coordinates attempts to overturn denials by drafting appeals , negotiating with payers, or following up with payer utilization review… more
- ProMedica Health System (Toledo, OH)
- …clinical. Experience with electronic record interfaces License: RN Certification: Prior oncology pre-certification/authorization PREFERRED QUALIFICATIONS Education: ... Bachelor's degree Skills: Specific knowledge of medical payers Years of Experience: Oncology experience; EPIC electronic health record experience WORKING CONDITIONS Personal Protective Equipment: Exposure to expected hospital conditions. Physical Demands:… 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 ... position may support UM, MPO, Coding, or Behavioral Health appeals . **Required Qualifications** * Must have active and unrestricted.... **Required Qualifications** * Must have active and unrestricted RN licensure in state of residence * 3+ years… more
- Genesis Healthcare (Philadelphia, PA)
- …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 denials. Other Info + Position Type: Full Time + Pay Target: $80,000-$95,000 / year + Job City: Philadelphia + Requisition Number: 509426 Genesis HealthCare, Inc. and all… 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 ... Utilization Management, Interqual Additional Skills & Qualifications: + CA RN License required + 5+ years of RN... RN License required + 5+ years of RN or healthcare experiences to be considered + This… more