Nursing - Appeal Analyst RN I

3 weeks ago


Wall, United States Integrated Resources, Inc Full time
Job Description:
The Client UM Appeals Department is looking for a seasoned UM Appeals Nurse to join our team for a 6 month timeframe. The primary role includes:

Review of Level 2 Commercial Appeals. This includes review and investigation of the reason for the UM denial, appeal request and review of additional information provided.

Qualifications:
" Active Unrestricted RN License NJ or Compact
" Technology Savvy Ability to navigate through multiple systems and type 100 words per minute. Client utilized systems including: Care Radius, Outlook, Teams, Onenote, Microsoft suite. Knowledge of these is a plus.
" Thrive in a fast paced environment
" Solid ability to present clinical information to a committee
" Make sound clinical judgements quickly to maintain turnaround time
" Proficient in review and investigation of a UM appeal. This includes understanding of regulations that guide our practices
" Health plan Appeals experience is a must. Prefer knowledge of UM Pharmacy appeals if possible
" Proficient with navigating UM policies and clinical guidelines
** Role is remote 8am-5pm
  • Analyst I

    2 weeks ago


    Wall, United States Integrated Resources, Inc Full time

    Review of Level 2 Commercial Appeals. Care Radius, Outlook, Teams, Onenote, Microsoft suite. Health plan Appeals experience is a must. Proficient with navigating UM policies and clinical guidelines ** Role is remote 8am-5pm

  • Budget Analyst II

    1 week ago


    Wall Twp, United States Hackensack Meridian Health Full time

    Overview Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives - and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It's also about how we support one...

  • RN Shift Supervisor

    4 weeks ago


    Wall, United States CareOne Full time

    Balance Life & Work with a New Career Opportunity(LONG TERM CARE)(SHORT TERM REHAB(SKILLED NURSING)Now Hiring – RN Shift Supervisor –Wall, NJCare One at WallThe RN Supervisor will be responsible for, but not limited to:Responsible for the day to day coordination and oversight of all aspects of nursing activities of the facility during her/his tour of...


  • Wall Township, United States BAYADA Home Health Care Full time

    Job DescriptionJob DescriptionAre you ready to love what you do? BAYADA Home Health Care is currently seeking a full-time Board-Certified Behavior Analyst (BCBA) to join the team in our ABA Center located in Wall, NJ. At BAYADA, we believe that our clients come first, and our employees are our greatest asset! Our core values are compassion, excellence, and...


  • Wall Township, United States BAYADA Home Health Care Full time

    Job DescriptionJob DescriptionAre you ready to love what you do? BAYADA Home Health Care is currently seeking a full-time Board-Certified Behavior Analyst (BCBA) to join the team in our ABA Center located in Wall, NJ. At BAYADA, we believe that our clients come first, and our employees are our greatest asset! Our core values are compassion, excellence, and...


  • Wall, United States Brandywine Living Full time

    Certified Nursing Assistant (CNA) - NJ Do you want to be part of a TEAM that changes lives? "Brandywine is a family and we succeed together. I can trust the people I work with and we are all involved in each other's growth and development. Also, we have fun! My advice to a new care manager is...don't be afraid to fall in love with your residents."-...

  • MDS Coordinator RN

    4 weeks ago


    Wall, United States CareOne Full time

    Balance Life & Work with a New Career Opportunity(LONG TERM CARE)(SHORT TERM REHAB)(SKILLED NURSING)(SUB ACUTE CARE)Now Hiring - MDS Coordinator - Wall, NJCare One WallThe MDS Coordinator will be responsible for, but not limited to:Direct the Resident Assessment Process through assisting with the completion of the Minimum Data Set (MDS) and CAA's.Participate...


  • Wall Twp, United States Pioneer Healthcare Services Full time

    PT - Skilled Nursing Facility - SNF - Physical Therapist Job Description: Pioneer Healthcare has an amazing opportunity for a 13 week contract. Skilled Nursing Facility - SNF PT who work for Pioneer Healthcare enjoy the positive work environment, and the incredible compensation pay packages. Pioneer Healthcare Services is dedicated to provide the highest...


  • Wall, United States Solutions by Sanford Full time

    Job Summary We are seeking experienced Registered Nurses to join our team as Traveling Critical Care RNs. This full-time position offers 12-hour rotating shifts with 36 hours per week and a competitive salary range. The RN will be responsible for providing individualized nursing care to patients in a Vascular Center in Sioux Falls, SD. Collaborating with...

  • Registered Nurse

    2 months ago


    Wall Twp, United States Monarch Communities Full time

    Company DescriptionMonarch/Brandywine:Company Culture and Values: At Monarch Communities, we value compassion, innovation, and community. Our team is committed to making a meaningful impact on the lives of our residents and fostering a collaborative and supportive work environment. Job Description Reporting to the Director of Health and Wellness, the...

  • Registered Nurse

    2 months ago


    Wall Township, United States BAYADA Home Health Care Full time

    Come for the Flexibility, Stay for the Culture BAYADA Home Health Care was founded on the principle that health care gets better when clients get better care at home—the place they most want to be. Delivering care is our highest priority and greatest joy. We care for people of all ages, diagnoses, and acuity levels, giving you the chance to explore your...

  • Registered Nurse

    2 months ago


    Wall Township, United States BAYADA Home Health Care Full time

    Job DescriptionJob DescriptionCome for the Flexibility, Stay for the CultureBAYADA Home Health Care was founded on the principle that health care gets better when clients get better care at home—the place they most want to be. Delivering care is our highest priority and greatest joy. We care for people of all ages, diagnoses, and acuity levels, giving you...

  • MDS Coordinator LPN

    4 weeks ago


    Wall, United States CareOne Full time

    Balance Life & Work with a New Career Opportunity(LONG TERM CARE)(SHORT TERM REHAB)(SKILLED NURSING)(SUB ACUTE CARE)Now Hiring - MDS Coordinator - Wall, NJCare One WallThe MDS Coordinator will be responsible for, but not limited to:Direct the Resident Assessment Process through assisting with the completion of the Minimum Data Set (MDS) and CAA's.Participate...

  • RN / LPN - Wall

    6 months ago


    Wall Township, United States Samba Care Full time

    Samba Care - WE OFFER AMAZING PAY YOU WON'T FIND ANYWHERE ELSE!! SHIFTS AVAILABLE!!   Samba Care is currently seeking experienced Registered Nurse (RN) and Licensed Practical Nurse (LPN) to join its team, working at Long Term Care (LTC) facilities and hospitals throughout New Jersey! We offer great rates and flexible schedules. All shifts are available;...

  • Assisted Living RN

    2 weeks ago


    Wall Township, United States Tower Lodge Care Center Full time

    Tower Lodge Care Center - Tower Lodge Care Center, a 60-bed long term care and rehabilitation center located in Wall, NJ, is seeking outstanding  Registered Nurses (RN's) to join our team of professionals!We are offering a pleasant work environment and great benefits including medical, dental, vision and 401(k) with a Company match.We have 3-11 Full time...


  • Wall Lake, Iowa, United States White Glove Placement Full time

    Exciting RN - LTC OpportunityWhite Glove Placement is seeking a skilled Registered Nurse to fill a Long Term Care position. As a valued member of our team, you will have access to a wide range of job opportunities, including per diem and travel assignments. Our comprehensive benefits package includes premium insurance, housing benefits, paid sick time, and a...


  • Wall Township, NJ , USA, United States Atlas MedStaff Full time

    Travel Nurse RN OpportunityAtlas Medstaff is currently seeking a skilled Registered Nurse (RN) for a 13-week contract in the Neptune City area.We are a premier staffing firm dedicated to matching outstanding talent with exceptional opportunities.Estimated compensation package based on a usual week of work, inclusive of taxable hourly wage and expected weekly...

  • Nurse Care Specialist

    1 month ago


    Wall Lake, Iowa, United States BAYADA Home Health Care Full time

    BAYADA Home Health Care is seeking a skilled Nurse Care Specialist to provide high-quality care to clients in their homes.Job Description & RequirementsSpecialty: Home HealthDiscipline: RNDuration: OngoingEmployment Type: StaffBAYADA Home Health Care is committed to delivering exceptional care to clients of all ages and acuity levels. As a Nurse Care...

  • Nurse Care Specialist

    1 month ago


    Wall Lake, Iowa, United States Monarch Communities Full time

    At Monarch Communities, we are seeking a skilled Nurse Care Specialist to join our team. In this role, you will be responsible for conducting resident assessments and reassessments, providing direct nursing care to residents, and supervising the day-to-day nursing activities performed by LPN care staff.Responsibilities:Supervise care staff in accordance with...


  • Wall Twp, United States Hackensack Meridian Health Full time

    Company OverviewHackensack Meridian Health is a leading healthcare provider dedicated to delivering exceptional patient care and promoting a culture of compassion and excellence.Our organization is committed to transforming healthcare and making a positive impact on our community.Job DescriptionWe are seeking a skilled and compassionate Registered Nurse to...