- CHRISTUS Health (Alamogordo, NM)
- …Medicare Conditions of Participation, DNV standards, HIPAA, and reporting requirements. Submits appeals in a timely manner, upon request by the Director. Initiates ... Complies with the Utilization Management Plan. Requirements Education Required: Associate of Science Licenses & Certifications Required: L-RN Singlestate Preferred:… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Insurance Appeals Associate Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the region's top-performing ... timely follow-up with regard to clinical and medical necessity insurance appeals . Analyzes all correspondence regarding insurance denials for the Revenue Integrity… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Insurance Appeals Associate Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the region's top-performing ... || ### Responsibilities + Analyze denials and coordinates insurance appeals . + Recognizes situations which necessitate supervision and guidance, seeks… more
- CVS Health (Hartford, CT)
- …1+ years of Coding experience + Utilization Review experience + Medicare experience + Appeals experience Education + Associate RN Degree or RN Diploma required ... 8a-5p in time zone of residence. Position Summary The Appeals Nurse Consultant position is responsible for processing the...for processing the medical necessity of Medicare Part C appeals from both members and providers. This role is… more
- CVS Health (Hartford, CT)
- …Qualifications + Utilization Review experience + Medicare experience + Managed Care Appeals experience Education + Associate 's degree or RN diploma required ... designated time zone) with occasional weekends and holidays. The Appeals Nurse Consultant position is responsible for processing the...for processing the medical necessity of Medicare Part C appeals from both members and providers. This role is… more
- CVS Health (Richmond, VA)
- …Understanding of current Aetna healthcare systems and products including but not limited to HRP, GPS, ATV, MedCompass, Pharmacy systems, etc.-Experience working in a ... fast paced collaborative team environment while delivering a quality product.Prior management experience preferred but not required Preferred Qualifications Prior management experience preferred but not required Understanding of Complaint and Appeal Policies… more
- CVS Health (Harrisburg, PA)
- …to make health care more personal, convenient and affordable. Position Summary The Associate Manager will assist in the hiring and managing of the Medicare ... Complaints Team staff. The Associate Manager must possess outstanding people skills, exercise good judgement, and contribute to a team environment. Ability to build… more
- CVS Health (Carson City, NV)
- …affordable. Position Summary Responsible for managing to resolution of Fast Track Appeals for Medicare products, which may contain multiple issues and, may require ... issues and report and recommend solutions. Research incoming Medicare Fast Track appeals to identify if appropriate for unit based upon published business… more
- Universal Health Services (Richmond, VA)
- …or equivalent, Associate 's degree or higher preferred + 3-5 years appeals experience preferred + Strong Microsoft Office skills (Excel, Word, Outlook) + Ability ... Atlantic Region CBO is seeking a dynamic and talented Senior Appeals Specialist. The Senior Appeals Specialist is responsible for the resolution of all … 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...Education - Required GED, High School Education - Preferred Associate License and Certifications - Required License and Certifications… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- Centene Corporation (AZ)
- …and scanning incoming mail **Education/Experience:** High school diploma or equivalent. Associate 's degree preferred. 2+ years grievance or appeals , claims ... **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting… 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
- CareFirst (Baltimore, MD)
- …of the Clinical Medical Claims Review, Medical Underwriting, Medical Policy, Clinical Appeals and Analysis programs and Quality of Care Complaint Unit. May lead ... that week. **ESSENTIAL FUNCTIONS:** + Directs the Medical Review and Appeals units and manages multiple strategic clinical projects that span organizational… more
- CVS Health (Hartford, CT)
- …with occasional rotational weekend and holiday coverage. Position Summary The Appeals Nurse Consultant position is responsible for processing the medical necessity ... of Medicare Part C appeals from both members and providers. This role is...+ Exceptional verbal and written communication skills Education + Associate 's Degree or RN diploma required Pay Range The… 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...least 3 years of experience in clinical setting. **Education:** Associate 's Degree in Nursing (ADN) required, Bachelor's of Science… 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 ... well as collaborate with colleagues. **JOB QUALIFICATIONS** **Required Education** Associate degree or equivalent combination of education and experience **Required… more
- Martin's Point Health Care (Portland, ME)
- …in a managed care environment. + Medicare experience required. + Coding and appeals experience required. + Associate degree required; BSN preferred Required ... License(s) and/or Certification(s): + Unrestricted state license as a Registered Nurse + Certification in managed care nursing or care management desired (CMCN or CCM) Skills/Knowledge/Competencies (Behaviors): + Demonstrates an understanding of and alignment… more
- SUNY Geneseo (Geneseo, NY)
- Associate Provost for Academic Success Bookmark this Posting | Print Preview | Apply for this Job Please see Special Instructions for more details. Applicants should ... date is late June 2024. Vacancy Announcement Position Information Campus Title Associate Provost for Academic Success Department Office of the Provost Position… more
