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Nurse Appeals Jobs

Manager - Appeals Jobs
By Maximus At United States
Perform other duties as assigned by management.
Develop and administer schedules, performance requirements; may have budget responsibilities.
Manage teams and staff assigned.
In some instances this manager may be responsible for a functional area and not have any subordinate employees.
Follow processes and operational policies in selecting methods and techniques for obtaining solutions.
Act as advisor to subordinate(s) to meet schedules and/or resolve problems.
Appeals Nurse Consultant Jobs
By CVS Health At , Hartford $58,760 - $125,840 a year

Must have active and unrestricted RN licensure in state of residence

California RN license preferred (not required)

Rn Appeals Nurse (Hybrid)
By VillageCare At New York, NY, United States

Appeals Nurse (Hybrid) VillageCareMAX 112 Charles Street, New York, NY 10014 VillageCare is looking for a self-motivated and passionate RN for our Appeals Nurse position. While supporting the ...

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.
Appeals Analyst Jobs
By BlueCross BlueShield of South Carolina At South Carolina, United States
Excellent organizational and time management skills.
Continuing education funds for additional certifications and certification renewal
Two years clinical experience plus one year utilization/medical review, quality assurance, or home health, OR three years clinical.
Working knowledge of word processing software.
Strong clinical experience, including home health, rehabilitation, and broad medical surgical experience.
Knowledge of specific criteria/protocol sets and the use of the same.
Remote Va Appeals Clerk
By Jan Dils, Attorneys at Law At , , Ga $14.62 - $20.24 an hour
Remote Appeals Clerk Benefits include:
Become an expert on our Case Management Software, Adobe, and Microsoft Office that you will be using daily.
Remote Work – No commute – Work from home!
What you will be doing as a Remote Appeals Clerk:
Not only is the position itself great, but the benefits we offer are fantastic as well!
Health, Vision, & Dental Insurance
Registered Nurse (Rn) - Appeals & Grievances
By CareOregon At , Portland, 97204, Or $87,140 - $105,435 a year
Knowledge of utilization management practice principles and industry standard criteria
Knowledge, skills and abilities required
Maintain confidentiality of all discussions, records, and other data in connection with quality management activities according to professional standards
Knowledge of Oregon Health Plan benefit package including rules and regulations that pertain to health plan operations
Knowledge of Medicare A and B benefits and regulations that relate to Medicare Advantage plans
Physical Skills and Abilities Required
Nurse Appeals Jobs
By Elevance Health At Florida, United States
Job Family: Medical and Clinical
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Resolving member clinical grievances (complaints).
Conducts investigations and reviews of member grievances and potential quality of care issues.
Reviews medical records for potential quality of care issues.
Extrapolates and summarizes medical information for medical director.
Nurse Appeals Jobs
By Elevance Health At United States
Job Family: Medical and Clinical
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Resolving member clinical grievances (complaints).
Conducts investigations and reviews of member grievances and potential quality of care issues.
Reviews medical records for potential quality of care issues.
Extrapolates and summarizes medical information for medical director.
Clinical Appeals Nurse Jobs
By Netsmart At United States
At least 3 years of case management, concurrent review or utilization management experience
Prepare professional, effective clinical appeals in response to managed care, governmental, or RAC denials for hospital clients.
At least 5 years of clinical experience in acute care setting
Participate in telephonic Administrative Law Judge Hearings and present oral arguments for reversing Medicare denials.
Bachelor of Science degree in Nursing
Proficiency in medical record review
Appeals Nurse Jobs
By Netsmart At United States
At least 3 years of case management, concurrent review or utilization management experience
Prepare professional, effective clinical appeals in response to managed care, governmental, or RAC denials for hospital clients.
At least 5 years of clinical experience in acute care setting
Participate in telephonic Administrative Law Judge Hearings and present oral arguments for reversing Medicare denials.
Bachelor of Science degree in Nursing
Proficiency in medical record review
Appeals Nurse Jobs
By Mindlance At Ohio, United States
Experience with Utilization Review/Management--2 yrs
Utilization review nurse, appeal review nurse and direct patient care experience.
Share resume at : [email protected]
Behavior and accountability and ability to pivot when new priorities come up
Describe the performance expectations/metrics for this individual and their team:
What previous job titles or background work will in this role?
Nurse Appeals Jobs
By Elevance Health At Ashburn, VA, United States
Preferred Capabilities, Skills And Experiences
Location: Remote – OH, VA, NY, FL
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.
Nurse Appeals Jobs
By Elevance Health At Columbus, OH, United States
Preferred Capabilities, Skills And Experiences
Location: Remote – OH, VA, NY, FL
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.
Nurse Appeals Jobs
By Elevance Health At Richmond, VA, United States
Preferred Capabilities, Skills And Experiences
Location: Remote – OH, VA, NY, FL
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.
Nurse Appeals Jobs
By Elevance Health At Tampa, FL, United States
Preferred Capabilities, Skills And Experiences
Location: Remote – OH, VA, NY, FL
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.
Appeals Associate - Remote
By Piper Companies At Raleigh, NC, United States
1 - 3 years of experience in claims, customer service, medical office, health insurance or coding experience
Associate degree or higher preferred (HS Diploma considered with relevant experience)
Certified Professional Coder (CPC) certification required
Salary: $22-$25/hr, based on previous experience
Benefits: Medical, Dental, Vision, 401k
Responsibilities of the Appeals Associate:
Clinical Appeals Nurse Rn Wfh
By HCA Healthcare At Nashville, TN, United States
At least 1 year of case management experience required
Relevant education may substitute experience requirement
Education assistance (tuition, student loan, certification support, dependent scholarships)
Family support through fertility and family building benefits with Progyny and adoption assistance.
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
Demonstrate the ability to interpret medical payer policy requirements.
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.