Maryland Licensed Clinical Appeals NurseVirtualVocations • Riverside, California, United States
serp_jobs.error_messages.no_longer_accepting
Maryland Licensed Clinical Appeals Nurse
VirtualVocations • Riverside, California, United States
job_description.job_card.variable_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 Nurse (Remote).
Key Responsibilities
Investigates and analyzes written appeals and reconsideration requests, responding with detailed letters while adhering to corporate policies and regulations
Organizes appeal cases for physician review, compiling relevant information and communicating final decisions to members and providers
Utilizes nursing expertise to prioritize and assess appeal requests related to medical and behavioral health conditions, collaborating with external review organizations as necessary
Required Qualifications
High School Diploma or GED
Registered Nurse (RN) State Licensure required upon hire
2 years of medical-surgical or similar clinical experience, or 3 years in a mental health setting
Certified Case Manager (CCM) and / or Legal Nurse Consultant Certified (LNCC) preferred upon hire
Preferred BSN or MSN degree
serp_jobs.job_alerts.create_a_job
Licensed Clinical • Riverside, California, United States
Job_description.internal_linking.related_jobs A company is looking for a Clinical Specialist to join their remote team.Key Responsibilities Utilize motivational interviewing techniques to engage patients in services Complete necessary docum...serp_jobs.internal_linking.show_more A company is looking for a Telephonic Nurse Case Manager to manage medical claims and coordinate care for injured workers.
Key Responsibilities Provide telephonic case management in a Workers' Com...serp_jobs.internal_linking.show_more A company is looking for a Clinical Documentation Specialist, REMOTE.Key Responsibilities Ensure the accuracy and completeness of clinical documentation through extensive record reviews and inter...serp_jobs.internal_linking.show_more A company is looking for an Appeals Nurse Consultant - Work From Home.Key Responsibilities Review and resolve clinical appeals by interpreting data and applying clinical criteria Coordinate clin...serp_jobs.internal_linking.show_more A company is looking for a Clinical Review Nurse - Prior Authorization.Key Responsibilities Review both prior authorization (PA) and inpatient (IP) requests Complete up to 20 authorization revie...serp_jobs.internal_linking.show_more A company is looking for a Full-Time, Temporary Appeals and Grievances Specialist.Key Responsibilities Make independent decisions on Member Appeals impacting overall performance and CMS scoring ...serp_jobs.internal_linking.show_more A company is looking for a Nurse Case Manager - NICU who must reside and be licensed in South Carolina.Key Responsibilities Assess the needs of members and develop individualized care plans Moni...serp_jobs.internal_linking.show_more A company is looking for a Case Manager.Key Responsibilities Engage target members facing medical, mental health, and substance utilization disorders to build supportive relationships Conduct in...serp_jobs.internal_linking.show_more A company is looking for a Clinical Appeals Coordinator.Key Responsibilities Act as a liaison for statewide appeals and ensure compliance with State and NCQA requirements Review clinical informa...serp_jobs.internal_linking.show_more A company is looking for an Appeals M.Member Appeals to perform clinical reviews and adjudications of appeals and grievances cases.
Key Responsibilities Conduct individual case reviews for appeals...serp_jobs.internal_linking.show_more A company is looking for a Clinical Supervisor - PAC - UM EOS.Key Responsibilities Supervise and provide leadership to the Post-Acute Care team, ensuring timely completion of tasks Act as the le...serp_jobs.internal_linking.show_more A company is looking for a Medical Policy Analyst (Remote).Key Responsibilities Conduct in-depth research and evaluate medical literature for policy revisions Collaborate with the Medical Direct...serp_jobs.internal_linking.show_more A company is looking for a Nocturnist to provide clinical evaluation, assessment, and treatment for members using their platform.
Key Responsibilities Provide synchronous / asynchronous clinical eva...serp_jobs.internal_linking.show_more A company is looking for a Clinical Quality LPN for a short-term contract position.Key Responsibilities Perform administrative tasks related to Adverse Event referrals and case management Assist...serp_jobs.internal_linking.show_more A company is looking for an Out of Network (OON) Clinical Case Manager (CM) - Remote (CA Only) - Per diem - Variable.Key Responsibilities Coordinate quality healthcare services in out of network ...serp_jobs.internal_linking.show_more A company is looking for a Clinical Content Manager to lead the strategy and development of clinical content across various formats.
Key Responsibilities Create high-quality clinical content for m...serp_jobs.internal_linking.show_more A company is looking for a Pediatric and Adult Case Manager - Registered Nurse - Remote - Telehealth.Key Responsibilities Assess, plan, implement, and coordinate case management activities to eva...serp_jobs.internal_linking.show_more A company is looking for a Manager, Clinical Policy to join their Clinical Policy team.Key Responsibilities Evaluate vendor policy sets for compliance with internal and external medical standards...serp_jobs.internal_linking.show_more A company is looking for a Clinical Audit Lead.Key Responsibilities Supervises teams to ensure compliance with laws, regulations, and organizational policies Implements measures to mitigate risk...serp_jobs.internal_linking.show_more A company is looking for a Registered Nurse II - Case Manager.Key Responsibilities Manage continuity of care for beneficiary populations through comprehensive assessments and care planning Coord...serp_jobs.internal_linking.show_more
Florida Licensed Clinical Specialist
VirtualVocations • Corona, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_1_day • serp_jobs.job_card.promoted
Florida Licensed Nurse Case Manager
VirtualVocations • Riverside, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_hours • serp_jobs.job_card.promoted • serp_jobs.job_card.new
Georgia Licensed Clinical Documentation Specialist
VirtualVocations • Ontario, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
RN Appeals Nurse Consultant
VirtualVocations • Ontario, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Oregon Licensed Clinical Review Nurse
VirtualVocations • Irvine, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Medicare Appeals Specialist
VirtualVocations • Fontana, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
South Carolina Licensed Nurse Case Manager
VirtualVocations • Irvine, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_hours • serp_jobs.job_card.promoted • serp_jobs.job_card.new
Washington State Licensed Case Manager
VirtualVocations • San Bernardino, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Oregon Licensed Clinical Appeals Coordinator
VirtualVocations • San Bernardino, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
MD Appeals Medical Director
VirtualVocations • Moreno Valley, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
State Licensed Clinical Supervisor
VirtualVocations • Riverside, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_hours • serp_jobs.job_card.promoted • serp_jobs.job_card.new
Maryland Licensed Medical Policy Analyst
VirtualVocations • Mission Viejo, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_1_day • serp_jobs.job_card.promoted
Multi-State Licensed Nocturnist
VirtualVocations • Mission Viejo, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_1_day • serp_jobs.job_card.promoted
Hawaii Licensed Clinical Quality LPN
VirtualVocations • Mission Viejo, California, United States
serp_jobs.job_card.temporary
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
California Licensed Clinical Case Manager
VirtualVocations • Fontana, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_1_day • serp_jobs.job_card.promoted
State Licensed Clinical Content Manager
VirtualVocations • San Bernardino, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_1_day • serp_jobs.job_card.promoted
Compact Licensed Case Manager RN
VirtualVocations • Ontario, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Georgia Licensed Clinical Policy Manager
VirtualVocations • San Bernardino, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
State Licensed Clinical Audit Lead
VirtualVocations • Fontana, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_1_day • serp_jobs.job_card.promoted
Texas Licensed Case Manager Nurse
VirtualVocations • San Bernardino, California, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_hours • serp_jobs.job_card.promoted • serp_jobs.job_card.new