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Clinical Appeals Registered Nurse – Telecommute Jobs in California

Clinical Registered Nurse Jobs
By Institute on Aging At , San Francisco, 94118 $48 - $56 an hour
Manages minor illnesses, injuries, and the stable chronic illnesses of participants, according to standard procedures.
Preference will be given to those with experience in public health nursing, work with elders and/or acute care nursing.
At least two years of nursing experience at the RN level.
This range does not include any additional equity, benefits, or other non-monetary compensation which may be included.
Implements, directs, supervises and evaluates nursing care for participants of the IOA PACE program.
Participates in the health assessment and examination of applicants and participants; serves as a member of the Intake and Assessment Team.
Nurse Appeals (Contract) Jobs
By Elevance Health At , Los Angeles
Conducts investigations and reviews of member and provider medical necessity appeals.
Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity.
Extrapolates and summarizes medical information for medical director, consultants and other external review.
Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval.
Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.
Documents and logs appeal/grievance information on relevant tracking systems and mainframe systems.
Nurse Appeals Jobs
By Elevance Health At Palo Alto, CA, United States
Job Family: Medical and Clinical
Conducts investigations and reviews of member and provider medical necessity appeals.
Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity.
Extrapolates and summarizes medical information for medical director, consultants and other external review.
Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval.
Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.
Nurse Appeals Jobs
By Elevance Health At Costa Mesa, CA, United States
Job Family: Medical and Clinical
Conducts investigations and reviews of member and provider medical necessity appeals.
Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity.
Extrapolates and summarizes medical information for medical director, consultants and other external review.
Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval.
Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.
Nurse Appeals Jobs
By Elevance Health At Walnut Creek, CA, United States
Job Family: Medical and Clinical
Conducts investigations and reviews of member and provider medical necessity appeals.
Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity.
Extrapolates and summarizes medical information for medical director, consultants and other external review.
Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval.
Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.
Caregiver Support Registered Nurse Clinical Assessor
By US Veterans Health Administration At , San Diego, 92161, Ca $91,251 - $163,813 a year
If you are relying on your education to meet qualification requirements:
Advocates for Caregiver/Veteran dyads in ensuring availability of services and benefits for Caregivers and Veterans.
Completes comprehensive In-Home Assessments in accordance with program requirements. Maintains VISN directed, national and local safety requirements.
Provides consultation and education on Caregiver Support Program within the organization and to community Veterans and health care organizations.
Participates in development of educational tools and training to address specific caregiver needs and issues.
Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP)
Registered Nurse/Clinical Coordinator
By Wellness Clinic of Orange County At , Laguna Beach, 92651, Ca $140,000 a year

Registered Nurse, Clinical Coordinator for Ketamine & Vitamin infusion clinic. Job responsibilities include:

Laguna Beach, CA 92651: Reliably commute or planning to relocate before starting work (Required)

Are you a Registered Nurse looking for a unique opportunity to use your clinical expertise from the comfort of your own home? We are looking for a Clinical Appeals Registered Nurse to join our team and help us provide quality care to our patients. As a Clinical Appeals Registered Nurse, you will be responsible for reviewing appeals and making decisions based on clinical criteria. If you are looking for an exciting and rewarding career, this is the perfect opportunity for you!

Overview:

A Clinical Appeals Registered Nurse – Telecommute is a professional nurse who works remotely to review and process appeals for medical claims. The nurse is responsible for reviewing medical records, determining the validity of the appeal, and making a recommendation to the insurance company. The nurse must be knowledgeable in medical coding, billing, and appeals processes.

Detailed Job Description:

The Clinical Appeals Registered Nurse – Telecommute is responsible for reviewing medical records and claims to determine the validity of appeals. The nurse must be able to interpret medical records, understand medical coding and billing, and be familiar with the appeals process. The nurse must be able to make recommendations to the insurance company regarding the appeal. The nurse must also be able to communicate effectively with the insurance company and the patient.

What is Clinical Appeals Registered Nurse – Telecommute Job Skills Required?

• Knowledge of medical coding and billing
• Knowledge of the appeals process
• Ability to interpret medical records
• Ability to communicate effectively with insurance companies and patients
• Ability to make recommendations to insurance companies
• Ability to work independently

What is Clinical Appeals Registered Nurse – Telecommute Job Qualifications?

• Registered Nurse (RN) license
• Bachelor’s degree in Nursing
• 3+ years of experience in medical coding and billing
• Experience in the appeals process
• Excellent communication and interpersonal skills

What is Clinical Appeals Registered Nurse – Telecommute Job Knowledge?

• Knowledge of medical coding and billing
• Knowledge of the appeals process
• Knowledge of medical terminology
• Knowledge of medical records

What is Clinical Appeals Registered Nurse – Telecommute Job Experience?

• 3+ years of experience in medical coding and billing
• Experience in the appeals process
• Experience working with insurance companies

What is Clinical Appeals Registered Nurse – Telecommute Job Responsibilities?

• Review medical records and claims to determine the validity of appeals
• Interpret medical records
• Communicate effectively with insurance companies and patients
• Make recommendations to insurance companies
• Work independently and meet deadlines