A company is looking for an Appeals and Grievances Clinical Specialist - RN or LPN, 100% Remote.Key ResponsibilitiesManage clinical case development and resolution for member and provider complaintsPrepare cases for Medical Director Review and external appeals processesEnsure compliance with Federal and State regulations while managing caseloadsRequired QualificationsMust be an RN, LPN, or Dental HygienistBachelor's degree preferredExperience in clinical practice, appeals & grievances, or utilization managementUnderstanding of Utilization Review Guidelines and related regulationsAbility to work with care management systems and multiple computer applications
Appeals and Grievances Specialist
A company is looking for an Appeals and Grievances Specialist to ensure timely resolutions to member complaints and appeals in compliance with regulatory requirements. ...
EMS Clinical Practice BioTel Specialist (Paramedic)
Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrust...
Clinical Appeals Supervisor - RN
A company is looking for a Clinical Appeals Supervisor to oversee clinical denial reviews and appeals processes. ...
Clinical Nurse Coordinator RN Emergency Dept
In collaboration with other members of the management team, the CNC directs, monitors, and evaluates nursing care in accordance with established policies/procedures, serves as a resource person for staff, and models a commitment to the organization’s vision/mission/values to support an unparalleled ...
Clinical Abstraction Specialist - RN
A company is looking for a Clinical Abstraction Specialist responsible for data mining from patient electronic medical records. ...
RN or LVN - All Shifts
Forest Park Nursing & Rehabilitation provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran statu...
Charge Nurse - LVN or RN
The ability to regularly and timely attend work, cooperative and politely work and deal with others, and to effectively multi-task and work in a stressful environment are also essential functions to this job. We are an equal opportunity employer and prohibit discrimination/harassment without regard ...
Clinical Applications Specialist III (Hybrid) at Baylor Scott & White Health
The Clinical Applications Specialist III acts as a subject matter experienced in the support of one or more clinical applications. Helps implement third-party software and related application modules by assisting with software configuration and the development of incorporated workflows. This role de...
Main OR Clinical Nurse Coordinator RN Weekends
In collaboration with other members of the management team, the CNC directs, monitors, and evaluates nursing care in accordance with established policies/procedures, serves as a resource person for staff, and models a commitment to the organization’s vision/mission/values to support an unparalleled ...
Clinical Recruiting and Sourcing Specialist - Remote
Home Office Requirements: - Maximus provides company-issued computer equipment - Reliable high-speed internet service - Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity - Minimum 5 Mpbs upload speeds - Private and secure workspace #ClinicalServic...