UTILIZATION AND APPEALS COORDINATOR Registered Nurse

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...

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Analyze and resolve verbal and written claims and...

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...

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...

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Must reside within the state of Arizona. Position Purpose: Analyze and resolve...

Under general supervision of the Director of Case Management, the Utilization Review Nurse provides a clinical review of cases using medical necessity criteria to determine the medical appropriateness of inpatient and outpatient services. Provides feedback and assistance to other members of the healthcare team regarding the appropriate use of resources and...

About The RoleBHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity reviews while working remotely.Primary Responsibilities Perform prospective, concurrent, and retrospective utilization reviews and first level determination approvals for members using evidenced based guidelines,...

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Must reside within the state of Arizona. Position Purpose: Analyze and resolve...

Utilization Management Clinical Registered Nurse (RN)Job Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role performs telephonic...

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an...

Utilization Review NursePer Diem 1648 Huntingdon Pike Nursing RN/LPN Day SUMMARY OF JOB: To review each admission for appropriate assignment of level of care based upon clinical guidelines as well as to review documentation for continued stays daily and provide clinical information including assessments and outcomes for all payers and all levels of care...

Job Description:This position will be remote role for Nurses in MichiganShould have a valid MI RN LicenseShould Have utilization management experience.Should have experience completing post-acute reviews for the inpatient rehab, skilled nursing facility settings previously.The candidate should be well versed in coordination of care activities along with...

Utilization Management Clinical Registered Nurse - The Health Plan - RemoteJob Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role...

UTILIZATION REVIEW NURSE (RN)Randallstown, MDNORTHWEST HOSPITALNW CARE MANAGEMENTFull-time - Day shift - 8:00am-4:30pmRN Other81988Posted:March 21, 2024Apply NowSave JobSavedSummaryPosition Summary:Conducts concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to...

Your Role The Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Appeals and Grievances RN Senior will report to the Manager of the Appeals and Grievances team. In this role you will perform accurate and timely clinical review of...

Utilization Management Clinical Registered Nurse (RN) - The Health PlanJob Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role...

Care Coordinator Registered Nurse (Centralized Hospital Utilization )Job Summary We are searching for a Care Coordinator - someone who works well in a fast-paced setting. In this position, you will assess, plan, implement, monitor and evaluate the options and services required to meet an individual's health needs utilizing a collaborative approach....

The Utilization Review Nurse assists the utilization review process taking on various tasks including data collection of demographic, claim and medical information; analysis; and outcomes reporting. Utilizes standards of care, evidence based practices, Medicare and Medicaid and organizational coverage guidelines to assure members receive high quality, cost...

JOB DESCRIPTION Job Summary Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member and provider complaints and communicating resolution to members or  authorized representatives in accordance with the standards and requirements established by the Centers for...

Overview: *All positions are located in Fresno/Clovis CA**Up to $25K in bonus incentives (sign-on and relocation)*Opportunities for you!Join a Forbes Top 10 CA Employer!Direct impact on quality patient careTime and a half after 8 hrs + weekend and night differential (call pay for procedural areas)Free Continuing Education and certification including BLS,...