California Licensed Clinical Appeals RN
VirtualVocationsBeaumont, Texas, United Statesjob_description.job_card.1_day_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 - Remote (M-F working alternating Saturdays).
Key Responsibilities
Review medical records to verify service criteria compliance
Analyze pre-service appeals for clinical eligibility based on Plan benefits
Document determinations accurately while adhering to confidentiality regulations
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 M-F, 8 : 00-4 : 30 in their time zone and alternating Saturdays
serp_jobs.job_alerts.create_a_job
Clinical California • Beaumont, Texas, United States
Job_description.internal_linking.related_jobs A company is looking for a Nurse RN 3.Key Responsibilities Perform concurrent reviews of care episodes to determine medical necessity Utilize established criteria to support decision-making Ens...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days A company is looking for a Case Management Specialist to facilitate medical recovery and return to work for injured employees.
Key Responsibilities Conduct initial and ongoing clinical assessments...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days A company is looking for a Care Manager RN to support Ambetter Marketplace members remotely in Florida.Key Responsibilities Evaluate member needs and recommend care plans to address barriers to a...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days A company is looking for a Licensed Clinical Therapist (LCSW / LMHC / LMFT) for Adult Intensive Outpatient Virtual Group.
Key Responsibilities Provide virtual IOP remote group coverage via video confe...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for a Clinical Auditor 2.Key Responsibilities Performs audits of medical records for denials review, defense audits, disallowed charges, and utilization reviews Completes an...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days A company is looking for a Senior Clinical Revenue Applications & Support Analyst.Key Responsibilities Assists in determining technical solutions for business issues and integrates them with exis...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for a Licensed Clinical Therapist (LCSW / LPCC / LMFT) for a remote Adult Intensive Outpatient Program.
Key Responsibilities Provide virtual IOP remote group therapy via video con...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 A company is looking for a Registered Nurse Ambulatory Care Manager (RN) - Population Health.Key Responsibilities Provide clinical care management services to eligible patients, coordinating care...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days A company is looking for a Healthcare Clinical Evaluator SME, MD Required.Key Responsibilities Review prior authorizations (PAs) under the EPSDT program and adjudicate PDN and DME prior approval ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days A company is looking for a Licensing and Credentialing Specialist.Key Responsibilities Manage the process of securing and maintaining licenses, certifications, and permits for healthcare provider...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day A company is looking for a Field RN Case Manager.Key Responsibilities Manage and coordinate patient care in various settings, ensuring adherence to treatment plans Conduct assessments and evalua...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days A company is looking for a Collection Specialist responsible for collecting commercial, government, and patient balances.
Key Responsibilities Monitor outstanding account balances and determine ne...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days A company is looking for a Senior Employment Counsel.Key Responsibilities Provide legal advice on various employment law areas and engage in collaborative problem-solving Analyze and develop str...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days A company is looking for a Case Manager, Registered Nurse (Remote).Key Responsibilities Engage with members telephonically to coordinate their care and develop individualized care plans Provide ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day A company is looking for a Clinical Supervisor - RN - Full-time (Remote U.Key Responsibilities Lead and oversee all Utilization Management (UM) activities, ensuring accuracy and timely completion...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days A company is looking for a Claims Adjuster Workers Compensation.Key Responsibilities Analyze claims exposure and execute decision-making to resolve claims effectively Interact with various parti...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30 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_variable_days A company is looking for a Clinical Content Specialist-Temp.Key Responsibilities Assist in developing patient / provider education materials related to carrier screening Research genetic condition...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days A company is looking for a Case Manager located in Charlotte, NC; Raleigh, NC; or Orlando, FL.Key Responsibilities Serve as the primary contact for client, provider, and customer inquiries regard...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours A company is looking for a Represented Casualty Adjuster for a remote position in California.Key Responsibilities Initiate thorough coverage and liability investigations and draft coverage letter...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
- serp_jobs.job_card.promoted
California Licensed RN Nurse
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Ohio Licensed Case Management Specialist
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Florida Licensed Care Manager RN
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Florida Licensed Clinical Therapist
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Clinical Auditor with RN License
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Pennsylvania Licensed Clinical Analyst
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
California Licensed Clinical Therapist
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Ohio Licensed Ambulatory Care RN
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
North Carolina Licensed Clinical Evaluator
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
California Licensed Credentialing Specialist
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Ohio Licensed Field RN Case Manager
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
California Licensed Collection Specialist
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
California Licensed Employment Counsel
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Missouri Licensed Case Manager RN
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
Indiana Licensed Clinical Supervisor RN
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
California Licensed Claims Adjuster
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
North Carolina Licensed Case Manager
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
California Licensed Genetic Counselor
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
- serp_jobs.job_card.new
Case Manager (NC, FL Licensed)
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time
- serp_jobs.job_card.promoted
California Licensed Casualty Adjuster
VirtualVocationsBeaumont, Texas, United Statesserp_jobs.job_card.full_time