Talent.com
California Licensed Clinical Appeals RN

California Licensed Clinical Appeals RN

VirtualVocationsReno, Nevada, United States
job_description.job_card.30_days_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
job_description.job_card.job_description

A company is looking for a Clinical Appeals RN - Fully Remote.

Key Responsibilities

Review medical records to verify service criteria and clinical eligibility for coverage

Coordinate reviews with the Medical Director and document determinations accurately

Adhere to confidentiality regulations while interpreting Plan language

Required Qualifications

Active, unrestricted RN license in state of residence

2+ years of clinical experience as an RN in an acute, inpatient hospital setting

Proficiency in Microsoft Office, including Word and Outlook

Availability for 5-day work weeks, including weekdays and alternating weekends

serp_jobs.job_alerts.create_a_job

Clinical California • Reno, Nevada, United States

Job_description.internal_linking.related_jobs
  • serp_jobs.job_card.promoted
California Licensed Clinical Applications Professional

California Licensed Clinical Applications Professional

VirtualVocationsReno, Nevada, United States
serp_jobs.job_card.full_time
A company is looking for a Clinical Applications Professional 4 - Ambulatory.Key Responsibilities Lead the development, upgrade, enhancement, and support of Clinical Information systems Manage l...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
  • serp_jobs.job_card.promoted
North Carolina Licensed Case Manager

North Carolina Licensed Case Manager

VirtualVocationsReno, Nevada, United States
serp_jobs.job_card.full_time
A company is looking for a Remote Case Manager.Key Responsibilities Collaborate with a multidisciplinary healthcare team to monitor utilization patterns and facilitate appropriate care delivery ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
  • serp_jobs.job_card.promoted
  • serp_jobs.job_card.new
California Licensed Health Plans Auditor

California Licensed Health Plans Auditor

VirtualVocationsReno, Nevada, United States
serp_jobs.job_card.full_time
A company is looking for a Specialty Health Plans Auditor III, Claims.Key Responsibilities Lead planning, execution, reporting, and corrective action monitoring for claims processing compliance a...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
  • serp_jobs.job_card.promoted
California Licensed Utilization Management Nurse

California Licensed Utilization Management Nurse

VirtualVocationsReno, Nevada, United States
serp_jobs.job_card.full_time
A company is looking for a UM Nurse, RN for the Weekend Shift.Key Responsibilities Conduct prospective and concurrent / retrospective reviews of referrals to ensure compliance with regulatory requi...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
  • serp_jobs.job_card.promoted
Texas Licensed Utilization Management RN

Texas Licensed Utilization Management RN

VirtualVocationsReno, Nevada, United States
serp_jobs.job_card.full_time
A company is looking for a Fertility Utilization Management RN - Remote.Key Responsibilities Determine the appropriateness of inpatient and outpatient services based on medical guidelines and ben...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
  • serp_jobs.job_card.promoted
California Licensed Concurrent Review Nurse

California Licensed Concurrent Review Nurse

VirtualVocationsReno, Nevada, United States
serp_jobs.job_card.full_time
A company is looking for a Concurrent Review Nurse (RN) (Temporary).Key Responsibilities Performs concurrent, post-service, and retrospective reviews of acute in-patient care services using estab...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
  • serp_jobs.job_card.promoted
Texas Licensed Case Manager RN

Texas Licensed Case Manager RN

VirtualVocationsReno, Nevada, United States
serp_jobs.job_card.full_time
A company is looking for a Registered Nurse II - Case Manager.Key Responsibilities Manage continuity of care for beneficiaries through comprehensive assessments and care planning Coordinate foll...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
  • serp_jobs.job_card.promoted
Texas Licensed Bilingual RN Navigator

Texas Licensed Bilingual RN Navigator

VirtualVocationsReno, Nevada, United States
serp_jobs.job_card.full_time
A company is looking for a Remote Bilingual RN Care Navigator.Key Responsibilities Manage case management specific to kidney health, including member data entry and care coordination Educate mem...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
  • serp_jobs.job_card.promoted
Texas Licensed Clinical Appeals Coordinator

Texas Licensed Clinical Appeals Coordinator

VirtualVocationsReno, Nevada, United States
serp_jobs.job_card.full_time
A company is looking for a Clinical Appeals Coordinator.Key Responsibilities Act as the liaison for statewide appeals, ensuring compliance with State and NCQA requirements Review clinical inform...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
  • serp_jobs.job_card.promoted
Texas Licensed RN Case Manager

Texas Licensed RN Case Manager

VirtualVocationsReno, Nevada, United States
serp_jobs.job_card.full_time
A company is looking for a Case Manager RN.Key Responsibilities Assess member health status and coordinate care needs, including inpatient review and discharge planning Develop and implement tre...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
  • serp_jobs.job_card.promoted
Health Services Call Center Advisor (PERS & Non-Emergency Support)

Health Services Call Center Advisor (PERS & Non-Emergency Support)

Best Buy HealthFernley, NV, US
serp_jobs.job_card.full_time
Health Services Response Advisor.Consumer and Commercial PERS customers by receiving, evaluating and prioritizing emergency and non-emergency telephone and electronic requests for assistance.These ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
  • serp_jobs.job_card.promoted
Nurse Practitioner - Fallon NV

Nurse Practitioner - Fallon NV

MRG ExamsFernley, NV, United States
serp_jobs.job_card.full_time +1
Nurse Practitioner (NP) – Veteran Disability Assessments.VA's disability benefits process.Review and analyze electronic medical records via a secure web portal. Accurately document exam findings and...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
  • serp_jobs.job_card.promoted
California Licensed Bilingual LCSW

California Licensed Bilingual LCSW

VirtualVocationsReno, Nevada, United States
serp_jobs.job_card.full_time
A company is looking for a Remote Bilingual Licensed Clinical Social Worker (LCSW) with a California license required.Key Responsibilities Conduct comprehensive initial evaluations and establish ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
  • serp_jobs.job_card.promoted
Tennessee Licensed Appeals Coordinator

Tennessee Licensed Appeals Coordinator

VirtualVocationsReno, Nevada, United States
serp_jobs.job_card.full_time
A company is looking for an Appeals and Letters Coordinator remote position.Key Responsibilities : Process denial-related and member-oriented written communications in compliance with Federal and ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
  • serp_jobs.job_card.promoted
Locum Physician (MD / DO) - Family Practice in Herlong, CA

Locum Physician (MD / DO) - Family Practice in Herlong, CA

LocumJobsNetworkHerlong, CA, US
serp_jobs.job_card.full_time
LocumJobsNetwork is working with Adelphi Locums to find a qualified Family Practice MD in Herlong, California, 96113!.Adelphi is seeking a physician to provide services at a correctional facility i...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
  • serp_jobs.job_card.promoted
Locum Physician (MD / DO) - Family Practice in Herlong, CA

Locum Physician (MD / DO) - Family Practice in Herlong, CA

LocumJobsOnlineHerlong, CA, US
serp_jobs.job_card.full_time
LocumJobsOnline is working with Adelphi Locums to find a qualified Family Practice MD in Herlong, California, 96113!.Adelphi is seeking a physician to provide services at a correctional facility in...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
  • serp_jobs.job_card.promoted
California Licensed Product Counsel

California Licensed Product Counsel

VirtualVocationsReno, Nevada, United States
serp_jobs.job_card.full_time
A company is looking for a Product Counsel to provide legal guidance on financial products and related initiatives.Key Responsibilities Review new products and features, advising on legal risks a...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
  • serp_jobs.job_card.promoted
California Licensed Bilingual Nurse Practitioner

California Licensed Bilingual Nurse Practitioner

VirtualVocationsReno, Nevada, United States
serp_jobs.job_card.full_time
A company is looking for a Bilingual Family Nurse Practitioner (CA Licensed, Spanish Speaking).Key Responsibilities Provide virtual preventive care for underserved patients using internal care de...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day