Appeals Nurse Consultant

OverviewResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines – Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health. Ensures regulatory compliance, timeliness requirements and accuracy standards are met. Coordinates efficient functioning of day-to-day operations according to defined...

A healthcare organization in New Jersey is actively seeking a driven Appeal Analyst Nurse (RN) to join their staff in a remote capacity. In this role, the Appeal Analyst Nurse (RN) prepares and presents appeals to Provider Appeals Committee in accordance with criteria including coordination with independent URO.ResponsibilitiesThe Appeal Analyst Nurse...

DescriptionSummary: Responsible for the management and communication of denials/appeals received from third party payers, managed care companies, and/or government entities/auditors related to medical necessity and/or level of care. This associate will be a liaison and point of contact for clinical denials and appeal inquiries. The Clinical Appeals Nurse...

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...

SUMMARY The Pediatric Neurologist will provide clinical care to children with conditions of a wide range of neurological disorders including seizures, headaches, migraines, tics/tourette's, concussion, developmental delays, neuromuscular issues, attention/focus issues, syncope, and spells of abnormal behavior. The clinical focus will be in the ambulatory...

Fiducient Advisors provides tailored and personalized investment consulting services to clients such as retirement plan sponsors, endowments and foundations, private clients, and financial institutions. We operate with over 200 professionals nationwide, supporting our distinct purpose of helping clients prosper. The Consulting Analyst is responsible for...

SUMMARY The Pediatric Neurologist will provide clinical care to children with conditions of a wide range of neurological disorders including seizures, headaches, migraines, tics/tourette's, concussion, developmental delays, neuromuscular issues, attention/focus issues, syncope, and spells of abnormal behavior. The clinical focus will be in the...

Trinity Health Of New England is seeking a full-time Nurse Practitioner or Physician Assistant to join the Heart Failure team at Saint Francis Hospital and Medical Center located in Hartford, Connecticut. Join an established, growing heart failure interdisciplinary team and work alongside three board certified Heart Failure Attendings and five APPs. Daily...

Excellent career growth opportunities Join us and find a career that supports: • Diversity, equity, inclusion, and belonging • Growth and training In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial...

Description:Job Title:Design Consultant IReports To:Sales ManagerSalary:Base + CommissionBenefits:100% 401K match up to 4%, 3-tier medical insurance, 2-tier dental insurance, vision insurance, employer paid life insurance, critical illness, hospital indemnity & accident insurance, $3,000 tuition reimbursement, PTO.Purpose:The Design Consultant is responsible...

Job Schedule: Full Time Job Shift: Shift 1 Shift Details: Get MORE from your career with Hartford HealthCare Hartford HealthCare, the largest and most integrated healthcare system in Connecticut, has a new opportunity available for a Cardiology Nurse Practitioner or Physician Assistant, to provide Cardiac Catheterization Services in a high volume...

Completes thorough but appropriately focused evaluations of pediatric patients (from children to young adults), including competent and age appropriate histories and examinations. Identifies level of illness severity in a timely manner. Presents thoughtful assessments to the supervising physician and works towards prescribing necessary care plans. Performs...

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...

Description Job Schedule: Full Time Job Shift: Shift 1 Shift Details: Enhanced Tuition Assistance and Higher Education Partnerships Voluntary benefits include student loan programs, home, auto, renters insurance, identity theft protection, legal services, pet insurance and more! Family care benefits through Care.com including ...

Job Schedule: Per Diem Job Shift: Shift 1 Shift Details: 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 HealthCare is Connecticut’s most comprehensive, integrated health care system, affiliated with six of the...

Completes thorough but appropriately focused evaluations of newborns primarily in the Well Newborn Nurseries, including competent and age appropriate histories and examinations. Identifies level of illness severity in a timely manner. Presents thoughtful assessments to the supervising physician and works towards prescribing necessary care plans. Performs...

Job Schedule: Full Time Job Shift: Shift 1 Shift Details: Enhanced Tuition Assistance and Higher Education Partnerships Voluntary benefits include student loan programs, home, auto, renters insurance, identity theft protection, legal services, pet insurance and more! Family care benefits through Care.com including emergency back-up...

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we...

POSITION SUMMARY:The primary role of the Legal Nurse Consultant (LNC) is to analyze medical issues in professional liability cases and long term care litigation and to play a supportive role to Steptoe & Johnson attorneys in the delivery of high quality legal services. This is a full-time position in the Louisville, KY office. Remote work is not...

DescriptionJob Schedule: Full TimeStandard Hours: 40Job Shift: Shift 1Shift Details: 10 hour days, rotating q 6 weekend and 2 times per year holiday coverageWork 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 you to...