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Clinical Appeals Registered Nurse – Telecommute Jobs

Clinical Appeals - Rn
By Confluence Health At Wenatchee, WA, United States
Ability to write articulate and concise appeals by applying clinical knowledge, coding expertise and medical necessity.
Manages assigned workload of accounts so that appeals are submitted timely in accordance with payer timeframes.
Three (3) years of acute care experience or equivalent expertise.
Two (2) years’ experience in utilization review.
Strong attention to detail with excellent communication skills in both written and verbal forms.
2+ years experience working in the Epic system.
Clinical Appeals Analyst Jobs
By Piper Companies At United States
Review clinical information and consider Utilization Management Criteria and Corporate Medical Policy to determine medical necessity and appropriateness of care
3 + years of health insurance experience, preferably in claims or customer service
Salary: $35-$38/hr. based on relative experience
Comprehensive Benefits: Medical, Dental, Vision, 401k
Responsibilities of the RN Clinical Appeals Analyst:
Qualifications of the RN Clinical Appeals Analyst:
Registered Nurse - Clinical Leader
By State University of New York Upstate Medical University At Syracuse, NY, United States

Job Summary: The Clinical Leader provides operations based support to the nursing unit and exemplifies the Upstate mission, vision, and values acting in accordance with Upstate policies and ...

Appeals And Grievances Quality Nurse
By WellSense Health Plan At , Remote
Maintains current knowledge of regulatory, contractual and accreditation requirements subject matter expert
2+ years of experience in a managed care healthcare setting
2+ years of Utilization Management (Helpful)
Comprehensive knowledge of Medicaid and Medicare contractual provisions and NCQA accreditation requirements highly desirable
Exceptional customer service skills and experience working with diverse populations required
Assists with calibration sessions in accordance with department standards, to help ensure consistency and validation of audit parameters, KPIs, and requirements
Clinical Denials & Appeals Specialist (Registered Nurse) Remote
By Northwell Health At , Melville, 11747, Ny $78,000 - $130,000 a year

Remote Work Schedule: Sun-Thurs/8:30AM - 4:30PM

Registered Nurse (Clinical Educator)
By US Veterans Health Administration At , Cape Coral, Fl $65,332 - $126,060 a year
If you are relying on your education to meet qualification requirements:
Adult education experience - Preferred
Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
National Certification in applicable areas - Preferred
Nurse I Level I - An Associate Degree (ADN) or Diploma in Nursing, with no additional nursing practice/experience required.
You will be evaluated for this job based on how well you meet the qualifications above.
Nurse Appeals Jobs
By Elevance Health At Greater Indianapolis, United States
Preferred Skills, Capabilities, And Experiences
Job Family: Medical and Clinical
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
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 directors, consultants, and other external review.
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)
Clinical Manager-Registered Nurse Jobs
By Plastic Surgery Group (Skin and Aesthetic Centers) At , Montclair, 07042, Nj
Train new staff and provide continuing education for current staff
Experience in Plastic Surgery/Aesthetics preferred
Comprehensive medical plan offerings with S&A contributing an average of 80% toward premiums.
Extensive ancillary benefits: dental, vision, voluntary life insurance, hospital indemnity, critical illness, EAP, and more!
Benefits of Joining Plastic Surgery Group/Skin & Aesthetic Centers
Operating Room cases and procedures (with Scheduler)
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)

Clinical Appeals Nurse Jobs
By Beaumont Services Center At , Southfield, 48034, Mi
Must be detail oriented and must possess excellent time management and organizational skills.
10. Identifies and refers cases appropriately for Case Management, Quality Improvement for education and process improvement.
Background in Case Management preferred.
5. Collaborates with Case Management, HIM and/or other team members to determine appropriate responses when necessary.
Beaumont offers a comprehensive benefits package to meet your financial, health and life-work balance goals.
Minimum of two (2) years related experience in health care.
Registered Nurse (Telehealth Clinical Technician)
By US Veterans Health Administration At , Lorain, Oh $76,502 - $140,628 a year
Provides patient and family health education with a focus on self- management, prevention, and wellness, based on the patient's goals.
Providing patient and family health education with a focus on self-management, prevention, and wellness, based on the patient's goals.
If you are relying on your education to meet qualification requirements:
Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
Nurse I Level I - An Associate Degree (ADN) or Diploma in Nursing, with no additional nursing practice/experience required.
VA offers a comprehensive total rewards package: VA Nurse Total Rewards
Registered Nurse, Cdi (Clinical Documentation Improvement)
By Northside Hospital Inc. At , Cumming, 30041, Ga
Ability to interact with a wide range of personnel (treating physicians, nurses, CDISs, case managers, quality staff, and coders).
Excellent oral and written communications skills.
Experience in CQI concepts and tools and techniques.
Current RN license in Georgia.
Ability to interact with numerous facilities and departments. Proficiency in Excel and Word.
Case Appeals Nurse Jobs
By Good Samaritan Hospital At , Suffern, 10901, Ny
Must have working knowledge of utilization management, case management and process improvement.
Must have base knowledge of clinical coding and reimbursement and/or claims management.
Must have demonstrated knowledge of industry trends in Managed Care.
Must have demonstrated expertise in insurance, managed care and federal/ state coverage.
Work requires a high level of problem solving skills.
Must have clear and concise writing skills.
Registered Nurse - Clinical Dermatology
By Mayo Clinic At , Rochester, 55905, Mn $33.07 - $49.60 an hour
Current RN license by applicable state requirements.
Additional specialty certification/training as required by the work area.
American Heart Association (Title: BLS for Healthcare Providers or BLS Provider)
Red Cross (Title: CPR/AED for Professional Rescuers and Health Care Providers or BLS for Healthcare Providers)
Internal applicants should attach their three most recent performance appraisals.
Must obtain prior to start date:
Registered Nurse - Clinical Specialty Anticoagulation (Remote)
By Allina Health System At , Minneapolis, 55407, Mn
Acquires and applies the knowledge gained from educational experiences to current nursing practice.
Shares knowledge and skills in practice settings.
Attains knowledge and competency that reflects current nursing practice.
Participates in educational activities related to nursing practice.
Partners with others to effect change and generate positive outcomes through knowledge of the patient or situation.
Serves as a patient advocate assisting patients in developing skills for self-advocacy
Clinical Coordinator - Registered Nurse
By Halifax Health At Daytona Beach, FL, United States
Baccalaureate Degree in Nursing, Health Care Management or administration or equivalent preferred
Previous Charge Nurse experience preferred
Graduate from an accredited School of Nursing
Current valid Florida RN license
Clinical Registered Nures (Rn) Appeals & Grievences - Remote
By Commonwealth Care Alliance At , Boston, 02108, Ma
Provide clinical care to members via telehealth technologies (video, chat, etc.) for a clinically appropriate clinical care and care management services.
3+ years of nursing experience in a Managed Care setting is required
5+ years of clinical nursing experience is strongly
Experience in Medicaid/Medicare grievances and appeals and/or Utilization Review is strongly preferred.
Requires strong oral, written and interpersonal communication skills, problem-solving skills, and analytical
Strong interpersonal, verbal and written communication skills preferred
Clinical Registered Nures (Rn) Appeals & Grievences - Remote | Wfh
By Get It Recruit - Healthcare At Boston, MA, United States

We're seeking a highly motivated and skilled Medical Affairs Specialist to join our team. As our Medical Affairs Specialist, you will play a critical role in advancing our mission to improve patient ...

Clinical Registered Nurse Manager Mom Baby Postpartum And Antepartum
By Intermountain Healthcare At , Denver, 80218, Co
Providing management and oversight of daily Nursing activities to a Nursing Department.
Current BLS certification endorsed by the American Heart Association, required
Minimum of five (5) years of clinical RN experience, required-
Minimum of (3) years of experience in progressive RN leadership positions, required
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
This position is responsible for:

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