Clinical Appeals RN - Santa Ana

· SUMMARY · The Clinical Appeals Nurse is responsible for investigating and processing medical necessity appeals from members and providers to payers. Possesses the ability to conduct research on standards or practice, regulations, and policy relevant to any case. Responsible fo ...

SUMMARY · The Clinical Appeals Nurse is responsible for investigating and processing medical necessity appeals from members and providers to payers. Possesses the ability to conduct research on standards or practice, regulations, and policy relevant to any case. Responsible for o ...

The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances (analyzing, reviewing, and evaluating appeals and grievances), and acting as a Clinical Interface Liaison (clinical problem solver with facilities, providers, carriers resolution of ...

+The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances (analyzing, reviewing, and evaluating appeals and grievances), and acting as a Clinical Interface Liaison (clinical problem solver with facilities, providers, carriers, resolution o ...

This position follows a hybrid schedule with three (3) days in-office days per week (potentially more). Our office is located at 5701 Katella Ave., Cypress, CA 90630. · At UnitedHealthcare, we're simplifying the health care experience, · The Clinical Appeals Representative needs ...

This position follows a hybrid schedule with three (3) days in-office days per week. At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of peop ...

The Clinical Review Nurse evaluates medical records and clinical documentation to support the resolution of claims member grievances appeals and quality-of-care concerns. · ...

The Clinical Review Nurse evaluates medical records and clinical documentation to support the resolution of claims, member grievances, appeals, and quality-of-care concerns.Using clinical judgment and appropriate application of CMS regulations, Medicare Advantage requirements, an ...

Description · Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.    · Who Are We?   · Clever Care was created to meet the ...

Bring your expertise to a leadership role where mentorship, strategy, and impact intersect to assist your community. · The Supervising Attorney for the Public Benefits Unit is responsible for supervising CLA SoCal's public benefits and unemployment insurance benefits practice. · ...

The Senior Claims Specialist is responsible for ensuring accurate and compliant claim submission payment posting denial resolution and billing follow-up for CalAIM contracted services. · ...

The CalAIM Senior Claims Specialist is responsible for ensuring accurate and compliant claim submission payment posting denial resolution and billing follow-up for CalAIM contracted services. · This position plays a critical role in supporting the organization's revenue cycle by ...

· SUMMARY · Under direction of the Utilization Review Technician Supervisor, the Utilization Review Technician coordinates with the Utilization Management Department while being responsible for coordinating phone calls, clinical requests, upkeeps data entry, organizes denials an ...

Under direction of the Utilization Review Technician Supervisor, coordinates phone calls and data entry. Monitors patient charts and records to provide to responsible parties. · Reviews treatment plans and status of approvals from insurers. Collects and compiles data as required. ...

WearelookingforanexperiencedUtilizationManagementAppealsReviewNursetojoinourteam.TheidealcandidatewillhaveaprofessionallicensureasLVNorRNandatleasttwoyearsofexperienceinutilizationmanagement. · ...

The Grievance and Appeals Nurse Specialist manages medical appeals and state hearing reviews across all lines of business, · handling both expedited and standard requests.This role ensures compliance with regulations,policies,and procedures while preparing case narratives and pos ...

SUMMARY · Under direction of the Utilization Review Technician Supervisor, the Utilization Review Technician coordinates with the Utilization Management Department while being responsible for coordinating phone calls, clinical requests, upkeeps data entry, organizes denials and m ...

The Team You'll Join: We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. · ...

· Company Description · Healthcare Talent is assisting our client in hiring a Grievance & Appeals Nurse Specialist. The ideal candidate will manage the department work activities to ensure that service standards are met, and operations are consistent with the health plan policie ...

Who We Are · UCI Health is the clinical enterprise of the University of California, Irvine, and the only academic health system based in Orange County. UCI Health is comprised of its main campus, UCI Medical Center, a 459-bed, acute care hospital in in Orange, Calif., four hospit ...