Clinical Appeals Nurse - Baltimore, MD

The Clinical Appeals Nurse completes research and evaluation of member and provider disputes regarding adverse decisions. · Investigates appeals requests using nursing expert knowledge. · Responds to such requests with original letters upholding corporate policies and decisions. ...

The Clinical Appeals Nurse completes research and evaluation of member and provider disputes regarding adverse decisions. The incumbent will work remotely from within the greater Baltimore metropolitan area and come into a CareFirst location periodically for meetings training and ...

The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all applicable State and Federal rules and regulati ...

We are looking for an experienced clinician to work remotely from within the greater Baltimore metropolitan area. · The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. · ...

The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding adverse and adverse coverage decisions. · ...

+ Job summary: The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding adverse coverage decisions. + Qualifications: High School Diploma or GED, RN - Registered Nurse - State Licensure And/or Compact State Licensure ...

We are looking for an experienced clinician to work remotely from within the greater Baltimore metropolitan area. ...

We are looking for an experienced clinician to work remotely from within the greater Baltimore metropolitan area. · The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding adverse and adverse coverage decisions. · We ...

This role manages the appeal process for members and providers who appeal on behalf of members for Commercial lines of business.This position is responsible for ensuring quality management of the clinical appeal process to reduce the risk of State and Federal Regulatory fines and ...

The Appeals · Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, · and determination of next steps for Commercial and FEP lines of business.The role requires collecting, · organizing and tracking information to facilitate and expedit ...

The Appeals Specialist I is responsible for analyzing appeals and/or grievance correspondence, · and determining next steps for Commercial and FEP lines of business.We are looking for an experienced professional to work remotely · from within the greater Baltimore metropolitan ar ...

The Appeals Specialist I is responsible for the initial analysis of appeals and grievance correspondence, · and determination of next steps for Government Program lines of business.We are looking for an experienced professional to work remotely from within the greater Baltimore m ...

The Appeals Specialist I is responsible for the initial analysis of appeals and grievance correspondence, · The incumbent is responsible for collecting, organizing and tracking information to facilitate and expedite processing of appeals and grievances received from a variety of ...

This role manages the appeal process for members and providers who appeal on behalf of members for Commercial lines of business. · ...

The Appeals Specialist I is responsible for the initial analysis of appeals and grievance correspondence, and determination of next steps for Commercial and Government Program lines of business. The incumbent is responsible for collecting, organizing and tracking information to f ...

Seeking a Medical Review Nurse for long term contract position with major Healthcare Insurance organization in Maryland area. · ...

The Appeals Specialist I is responsible for the initial analysis of appeals and grievance correspondence, · and determination of next steps for Commercial and Government Program lines of business. · ...

We are looking for a Director, Medical Review & Appeals for our Government Programs lines of business. · ...

We are seeking a Clinical Nurse who will coordinate and provide the various clinical activities and nursing case management services to patients across sub-specialties within the Johns Hopkins Division of RheumatologyCounsel, support, educate, and coordinate resources needed by p ...

The Clinical Medical Review Nurse handles day to day review of professional and institutional claims. · The incumbent will handle pre and post claim medical review for Commercial, FEP and Medicare Advantage Plans. · ...