APPEALS NURSE CONSULTANT

The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare Part C appeals from both members and providers. This role is considered a production role and remains as part of the Nurse Appeal Consultant job cod Appeals, Nurse, Consultant, Remote, Clinical, Technology, Retail, RN

The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare Part C appeals from both members and providers. This role is considered a production role and remains as part of the Nurse Appeal Consultant job cod Appeals, Nurse, Consultant, Remote, Health, Technology, Retail, Benefits

This position will be working from home anywhere in the US. Standard business hours 8 a-5 p in time zone of residence Monday - Friday. The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare appeals for p Appeals, Nurse, Consultant, Remote, Health, Technology, Retail, Benefits

Help us lead change and transform the member experience The health care industry is changing, and Wellmark is working to help change it for the better. We recognize that our members deserve health care with a focus on quality. We also recognize that Clinical, Registered Nurse, Consultant, Nurse, Registered, Appeals, Healthcare

Position SummaryThe Appeals Nurse Coordinator II will provide concurrent review and appeal support services for XSOLIS's growing client base. An Appeals Nurse Coordinator II will have experience with utilization management, DRG clinical validation, understand the state and federal regulations, have knowledge/experience with the denials and appeals process...

**JOB DESCRIPTION****Job Summary**Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance standards.**We are seeking a Registered Nurse with previous Inpatient/outpatient appeals knowledge/experience. The candidate should have MCG criteria knowledge, critical thinking skills, and strong...

Job Title: Nursing - Appeal Analyst RN ILocation: Remote ( Wall NJ)Remote role candidate is required to be 100% onsite for training (1-2 weeks or as required).Duration: 3 Months + possible extension Job Description: Appeal Analyst RN who will train new hire in the clinical role to complete Utilization Management Appeals and act as an RN II on the team....

Our Client, Provides health insurance for low-income individuals, is seeking an Appeals & Grievances Nurse Specialist RN.Location: Los Angeles, CA (Remote)Position Type: ContractJob summary: • The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct assistance to member's with health care access or...

Appeal Experience REQUIREDRESPONSIBLE FOR:Detailed review, analysis and extraction of clinical information from patient medical records and drafting ofeffective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied casesunder appeal at all levels of the government appeals process; maintaining current knowledge base...

Job DescriptionECU HealthAbout ECU Health Medical CenterECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet designation twice and...

VOTED by our Staff TOP WORKPLACE for 13 YEARS! - Hartford Courant, 2023.InterCommunity, Inc is a FQHC LA (Federally Qualified Health Center Look Alike). Our health center provides same-day primary care services to every member of the community, regardless of life situation or ability to pay. We also provide a wide array of behavioral health services. Our...

Job SummaryRegistered Nurse who is responsible for performing Audits and Clinical Appeals as related to medical necessity, appropriateness of patient status and providing education and guidance to practitioners and other team members.Essential Functions* Identifies accounts and actions to secure compliance for Medicare and Medicaid.* Prepares and processes...

Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five...

MedWiz Pharmacy of New York is a leading provider of long-term care & skilled nursing pharmacy services. We are actively seeking people like you- passionate, highly skilled and motivated to make a difference!Join the MedWiz of New York team as a pharmacy nurse consultant where you will provide outstanding clinical services to our facilities and collaborate...

Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five...

assumes client care responsibilities inclusive of professional diagnosis and prescribing and/or administering treatment; applies medical knowledge and skills to the process of diagnosis, prevention and treatment of illnesses; Other duties include consultation regarding diagnosis and treatment to other agency staff or to community partners including emergency...

UC Health is hiring a full time Nursing Workforce Consultant.The Nursing Workforce Consultant will work in collaboration with nursing leadership, human resources, and talent acquisition on strategic nursing related workforce, retention strategies, developing pipelines, nursing recruitment, and nursing career pathway programs. The consultant will use their...

Description Job Schedule: Full Time Standard Hours: 40 Job Shift: Shift 1 Shift Details: 10 hour days, rotating q 6 weekend and 2 times per year holiday coverage Work where every moment matters. Every day, almost 25,000 Hartford HealthCare employees come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite...

Your RoleThe Utilization Management team facilitates the review of requests for medical necessity to assure that care is provided to our members timely, at the correct level of care with quality and cost effectiveness standards. The Utilization Management Nurse Consultant will report to the Utilization Management Manager. In this role you will be an...

Job Schedule: Full Time Job Shift: Shift 1 Shift Details: Monday through Friday with some weekend expectations.   Every day, almost 30,000 Hartford HealthCare employees come to work with one thing in common: We invite you to become part of Connecticut’s most comprehensive healthcare network.  Hartford Hospital is one of the largest and...