A company is looking for a RN Appeals and Denials.Key Responsibilities : Screens denials for possible reconsideration, peer to peer, or formal appealCollaborates with utilization management staff regarding possible reconsideration with payorMonitors results of denial management activities, identifies trends, and escalates to appropriate individualsRequired Qualifications : Graduate of accredited school of nursing or education equivalency for licensingThree years hospital acute care registered nurse experience, with one year experience in utilization review and / or case managementProfessional License as a Registered Nurse in the state of work locationPhysical ability to lift / carry objects, perform various movements, and use vision and hearing effectivelyDay shift availability and 40 scheduled weekly hours
Appeals and Denials RN
A company is looking for a RN Appeals and Denials. ...
Appeals and Grievances - RN, Senior
The Appeals and Grievances RN Senior will report to the Manager of the Appeals and Grievances team. The successful RN candidate will review both medical and pharmacy member appeals for benefits, medical necessity, coding accuracy and medical policy compliance. The Appeals and Grievances team is resp...
Customer Solution Center Appeals and Grievances Nurse Specialist RN II
Conducts intake/triage and appropriate classification of Clinical A&G, and Pharmacy requests and makes accurate judgment on appeal, grievance, Provider Claim Disputes, medical records or other issues and follows procedures on how to handle each type of request and route to the appropriate area withi...
Manager, Clinical Denials & Appeals
Ensures efficient and effective operations through highly engaged staff and providers and is an integral member of the leadership team, developing and executing key strategic initiatives that adheres to and follows the mission of Adventist Health, with a focus on driving clinical outcomes and improv...
Locum Nurse Practitioner (NP) - Hematology and Oncology - $80 to $100 per hour in Salinas, CA
Nurse Practitioner needed in California for Hematology Oncology coverage. ...
Travel Registered Nurse - Labor/Delivery - ($4005/Week) in LA, California
Travel Registered Nurse - Labor/Delivery - ($4005/Week). ...
Licensed Psychiatric Nurse Practitioner (Virtual)
Remote Licensed Psychiatric Nurse Practitioner. We are excited to begin helping you if you are a fully-licensed, ANCC board-certified Psychiatric Nurse Practitioner with:. Are you a licensed Psychiatric Nurse looking to launch a private practice, or grow your existing practice? Headway can help you ...
Travel Nurse RN - Case Manager - $2,755 to $2,933 per week in Greenbrae, CA
Host Healthcare is an award-winning travel healthcare company with an immediate opening for this RN - Case Management position in. ...
Travel Registered Nurse - Case Manager - $2,905 per week in Saint Helena, CA
As a Traveler with Medical Talent, you`ll have the opportunity to work in diverse settings, expand your skill set, and make a difference in the lives of patients across various locations. ...
Travel Nurse RN - Case Manager - $2,530 per week in Greenbrae, CA
Client in CA seeking RN Case Manager to work days. Aside from the many museums that showcase California's history, there are also many historic sites and monuments. CoreMedical Group has hundreds of exciting and rewarding travel assignments throughout the country for Travel Allied Professionals and ...