Jobs: clinical appeals nurse

Job Description Job Description LVN RANGE $38.91-$55.62 RN RANGE $50-$85 Job Description: Conduct and investigate member and provider medical necessity appeals Review prospective, inpatient, and retrospective medical records of denied services for medical necessity Ensures appeals and grievances are resolved in a timely manner Prepare clinical reviews and...

Job DescriptionJob DescriptionLVN RANGE $38.91-$55.62RN RANGE $50-$85Job Description: Conduct and investigate member and provider medical necessity appealsReview prospective, inpatient, and retrospective medical records of denied services for medical necessityEnsures appeals and grievances are resolved in a timely mannerPrepare clinical reviews and provides...

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

Nurse Appeals- California candidates only Location:This is a virtual position and prefer candidates reside within 50 miles of an Elevance Health PulsePoint location. Schedule:Monday - Friday 8:00 am to 4:30 pm PST How you will make an impact: Responsible for investigating and processing and medical necessity appeals requests from members and providers....

Job Description ECU Health About ECU Health Medical Center ECU 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...

JOB SUMMARY The Clinical Appeal Coordinator will be responsible for reviewing, researching and appealing all Clinical Denials received for the organization. The Clinical Appeal Coordinator will need to conduct any training and education that is needed as a result of those denials. The Clinical Appeal Coordinator will work with Business Services,...

Job Type Full-time Description The Clinical Appeals Manager will oversee the clinical appeals process, ensuring timely and accurate handling of cases in alignment with state and federal regulations. The role includes conducting medical necessity reviews, advocating for clients' access to essential treatments, and acting as a liaison between clients and...

The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare appeals for participating providers. Primary duties may include, but are not limited to: Requesting clinical, research, extrapolating pertinent clin Appeals, Nurse, Consultant, Remote, Health, Technology, Retail, Benefits

The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare appeals for participating providers. Primary duties may include, but are not limited to: Requesting clinical, research, extrapolating pertinent clin Appeals, Nurse, Consultant, Remote, Health, Technology, Retail, Benefits

Job Title: Grievance and Appeals Nurse SpecialistCalOptima Health is seeking a highly motivated an experienced TEMP - Grievance & Appeals Nurse Specialist to join our team.The Grievance and Appeals Nurse Specialist participates in managing CalOptima Healths medical appeals and state hearing reviews for all lines of business, including handling expedited...

Summary SUMMARY:  Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits.  DUTIES & ESSENTIAL JOB FUNCTIONS:  NOTE: The following are the duties performed by employees in this classification.  However, employees may perform other related duties at an equivalent level.  Not all duties listed...

Nurse Appeals- California candidates only Location:This is a virtual position and prefer candidates reside within 50 miles of an Elevance Health PulsePoint location. Schedule:Monday - Friday 8:00 am to 4:30 pm PST Saturdays and Holidays required How you will make an impact: Responsible for investigating and processing and medical necessity appeals requests...

Nurse Appeals- California candidates only Location:This is a virtual position and prefer candidates reside within 50 miles of an Elevance Health PulsePoint location. Schedule:Monday - Friday 8:00 am to 4:30 pm PST Saturdays and Holidays required How you will make an impact: Responsible for investigating and processing and medical necessity appeals requests...

Job Description Summary: 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...

Job Description Summary: 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...

Job 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...

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...

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...

Summary SUMMARY:  Coordinates and executes the appeal process for all AHS facilities clinical appeals and third party audits.  DUTIES & ESSENTIAL JOB FUNCTIONS:  NOTE: The following are the duties performed by employees in this classification.  However, employees may perform other related duties at an equivalent level.  Not all duties listed...

Job Type Full-time Description The Appeals and Denials Specialist is responsible for triaging and writing DRG downgrades and clinical validation appeal letters for multiple clients. The Appeals and Denials Specialist will ensure appropriate action is taken within appeal deadlines. This position collaborates with the Appeals...