Grievance & Appeals Nurse (RN) - Columbus

Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. · Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly healt ...

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more conveni ...

We're seeking an Appeals Nurse Consultant to join our team. You'll play a critical role in ensuring fair and accurate resolution of clinical appeals by applying sound clinical judgment and regulatory knowledge. · ...

CVS Health is seeking a dedicated Appeals Nurse Consultant to join our remote team. In this role, you will be responsible for processing the medical necessity of Medicare appeals for participating providers. · This is a full-time telework position with standard hours of Monday–Fr ...

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. · At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize sa ...

We re building a world of health around every individual — shaping a more connected convenient and compassionate health experience. · Responsible for the review and resolution of clinical appeals. · Reviews documentation and interprets data obtained from clinical records to apply ...

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+We are seeking a Grievance & Appeals Nurse (RN) to investigate process medical necessity appeals requests from members providers. · + · The successful candidate will support legal management executive leadership managing State Fair Hearing External Medical Review requests acts r ...

The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies and procedures, and medically appropriate clinical guide ...

We believe that no one should have to navigate the cost and complexity of healthcare alone, and we're on a mission to make healthcare simpler and more effective for our millions of members. · The Registered Nurse (RN) – Appeals is responsible for managing all clinical appeal requ ...

We're committed to building diverse and inclusive teams - more than 2, 5200 of us and counting - so if you're excited about this position, we encourage you to apply - even if your experience doesn't match every requirement. · \/li\>/ul"> · Licensure: · Active · and current licens ...

+The Nurse Appeals is responsible for investigating and processing medical necessity appeals requests from members and providers. · +Conducts investigations and reviews of member and provider medical necessity appeals. · Reviews prospective, inpatient or retrospective medical rec ...

The Appeals and Grievance Coordinator is responsible for the processing and resolution of appeals grievances disputes from members providers. · Document all appeal requests or grievances upon receipt in the operating systems routes cases to appropriate clinical personnel for revi ...

The Appeals and Grievance Coordinator is responsible for the processing and resolution of appeals, grievances and disputes from members and providers. · Position Purpose · The Appeals and Grievance Coordinator is responsible for the processing and resolution of appeals, grievance ...

The Clinical Appeals Manager is responsible for daily operational management of Revenue Cycle Clinical Support staff, primarily involving the oversight of clinical appeals and denial analysis, resolution, and prevention for The Ohio State University Health System. · Leads staff o ...

+Job Summary · A Manager of Clinical Appeals is responsible for daily operational management of Revenue Cycle Clinical Support staff and oversees clinical appeals and denial analysis, resolution, and prevention. · +ResponsibilitiesLeads staff on analysis and resolution of adminis ...

The Clinical Financial Case Manager - RN implements and supports the philosophy, mission, values, standards, · policies and procedures of The Ohio State University Wexner Medical Center. The CFCM-RN functions within the multidisciplinary team to secure complex pre-authorizations ...

The Manager of Clinical Appeals will oversee clinical appeals and denial analysis for The Ohio State University Health System. · ...

The Ohio Department of Medicaid (ODM) is seeking a Registered Nurse (RN) to be a part of our Surveillance/Utilization Review Section (SURS).SURS helps review utilization of Medicaid services, detect fraud, waste and abuse and recover inappropriate payments to providers. · ...

Responsible for daily operational management of Revenue Cycle Clinical Support staff, primarily involving oversight of clinical appeals and denial analysis. · ...