- US Tech Solutions, Inc. (Columbia, SC)
- …of professional, inpatient or outpatient, facility benefits or services, and appeals . Documents decisions using indicated protocol sets or clinical guidelines. ... and in the state of hired, OR, active compact multistate unrestricted LPN license Skills: . Working knowledge of word processing software. Good judgment skills.… more
- US Tech Solutions, Inc. (Atlanta, GA)
- …other internal groups regarding determination status and results (seniors, pharmacists, appeals , etc). . Identify and elevate clinical inquiries to the pharmacist ... Skills: . Prior Authorization . Call handling experience. Education: . High School diploma or GED . Active pharmacy tech license required of the state they resist. more
- Scripps Health (San Diego, CA)
- …patient population. *Preferred Qualifications:* * Bachelor's degree preferred. * Notary license preferred. * Appeals experience preferred. **Job:** **Business ... of the applications, through to the highest level of appeals while adhering to all policies on fraud/abuse and...Benefits Agency. * Bilingual in Spanish. * CA Driver's License . * Ability to comprehend and apply knowledge of… more
- Fallon Health (Worcester, MA)
- …purpose** : Responsible for the coordination and timely completion of provider appeals . Serves as a liaison between Fallon Health and contracted and non-contracted ... providers with appeals regarding filing limit appeals , claim denials,...Bachelor's degree or equivalent combination of training and experience ** License /Certification** N/A **Experience** 2 years related experience, preferably in… more
- Magellan Health Services (San Diego, CA)
- Coordinates appeals process as assigned, attends to risk management issues associated with case management and processes appeal requests. In some cases may be ... medical necessity reviews. + Enters all data related to appeals and case reviews into a database. + Prepares...- Required GED, High School Education - Preferred Associate License and Certifications - Required License and… more
- Motion Recruitment Partners (Durham, NC)
- Clinical Appeals Analyst Durham, NC **100% Remote** Contract $35/hr -...This is a clinical role, need to have a License for 5 years and 3 years of clinical LPN, ... a possible contract to hire opening for a Clinical Appeals Analyst. They have over 4 million customers and...PT, or OT. + Appeals Experience is required **Desired Skills & Experience** +… more
- CVS Health (Hartford, CT)
- …anywhere in the US.**Responsibilities of this Medical Director role are related to Medicare Appeals .* Direct daily work on part C appeals (both provider and ... member/nonparticipating providers) and Part D appeals .* Provide direct support to appeal nurses and dedicated...eg, Clinical Practice or Health Care Industry * Medical License (MD) or (DO)* An Active state medical … more
- Iowa Department of Administrative Services (Des Moines, IA)
- Assistant Attorney General- Criminal Appeals Section Print (https://www.governmentjobs.com/careers/iowa/jobs/newprint/4519255) Assistant Attorney General- Criminal ... Appeals Section Salary $57,636.80 - $139,318.40 Annually Location Des...review, or prior appellate practice. This position requires a license , or the ability to obtain a license… more
- Kepro (Indianapolis, IN)
- … license to practice in the state of Indiana or a Compact license . + Previous healthcare/managed care Appeals experience. + 2+ years of healthcare/managed ... sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team....join our growing team. Job Summary: Our Utilization Management Appeals Nurse - LPN/RN will help orchestrate the seamless… more
- Elevance Health (Woodland Hills, CA)
- **Nurse Appeals - Licensed Nurse** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live in the state of California ... locations. **Shift:** Tuesday to Saturday from 8:00-5:00 pm PT The **Nurse Appeals ** is responsible for investigating and processing and medical necessity appeals… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the… more
- Centene Corporation (New York, NY)
- …perspective on workplace flexibility. **Must have a New York State clinical license .** **Position Purpose:** Performs clinical reviews needed to resolve and process ... appeals by reviewing medical records and clinical data to...Medicaid regulations preferred. Knowledge of utilization management processes preferred. ** License /Certification:** + LPN - Licensed Practical Nurse - State… more
- Adecco US, Inc. (Minneapolis, MN)
- Adecco Medical & Science is hiring Appeals Pharmacists! This role is work from home / remote. Please read below and apply with an updated resume for consideration. ... of medications, potential drug interactions, and clinical status for appeals requests . Conduct Quality Assurance and verify the...or Pharm D degree . Active and unrestricted Pharmacist license in state of residence . 2+ years of… more
- Rush Copley Medical Center (Aurora, IL)
- **Position Summary** : The Appeals Specialist RN reviews inpatient hospital denials, clinical validation requests, and upheld denials after physician-to-physician ... (P2P) discussions then conducts appeals , as appropriate. Monitors and tracks denial outcomes with...applications with focus on Resolute Hospital Billing. **POSITION REQUIREMENTS** ** License :** Registered Nurse (RN) in the State of IL… more
- R1 RCM (Boise, ID)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Nurse** , you will help review and interpret medical records to ... draft appeals of denied and underpaid claims. Every day you...deadlines are met. **Required Skills:** + Active Registered Nurse license + Active AHIMA or AAPC Coding Certification including… more
- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, April 29, 2024 Centers Plan for Healthy Living's goal is to ... Reviewer will handle expedited and standard requests and ensures that the appeals are processed in accordance with regulations, compliance standards and policy and… more
- Elevance Health (Denver, CO)
- …a town hall office meeting once a quarter. The **Pharmacist - Clinical Appeals ** is responsible for managing the selection and utilization of pharmaceuticals and ... registered pharmacist. + Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh)....the United States when conducting utilization review or an appeals consideration and cannot be located on a US… more
- Humana (Columbus, OH)
- …Medical Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... MD or DO degree + A current and unrestricted license in at least one jurisdiction and willing to...in at least one jurisdiction and willing to obtain license , as required, for various states in region of… more
- Molina Healthcare (OH)
- …users for operational and strategic analysis. This role supports our Appeals and Grievances team. **KNOWLEDGE/SKILLS/ABILITIES** + Performs research and analyses on ... of education and experience **Preferred Experience** 3-5 years **Preferred License , Certification, Association** Microsoft certification To all current Molina… more
- Universal Health Services (Richmond, VA)
- …Qualifications Education, Training, Experience and Licenses/Registrations Required: + Current RN license and maintained during employment in this position + At least ... 5 years of clinical experience in an acute care setting + CCDS certification within 2 years of hire date + Critical Care, Medical/Surgical or Emergency Department nursing preferred + Knowledge of care delivery documentation systems and related medical record… more
