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Nurse Appeals Associate Jobs

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.
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.
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.
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
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.
Qm Nurse Associate Jobs
By CVS Health At , , Ut $21.75 - $47.25 an hour

Utilization of clinical skills to support the documentation and communication of medical services and/or benefit administration determinations.

Ability to multitask, prioritize and effectively adapt to a fast paced changing environment