Talent.com
Maryland Licensed Clinical Appeals Nurse

Maryland Licensed Clinical Appeals Nurse

VirtualVocationsHialeah, Florida, United States
13 hours ago
Job type
  • Full-time
Job description

A company is looking for a Clinical Appeals Nurse (Remote).

Key Responsibilities

Investigates and analyzes written appeals and reconsideration requests, responding with detailed letters while adhering to corporate policies and regulations

Organizes appeal cases for physician review, compiling relevant information and communicating final decisions to members and providers

Utilizes nursing expertise to prioritize and assess appeal requests related to medical and behavioral health conditions, collaborating with external review organizations as necessary

Required Qualifications

High School Diploma or GED

Registered Nurse (RN) State Licensure required upon hire

2 years of medical-surgical or similar clinical experience, or 3 years in a mental health setting

Certified Case Manager (CCM) and / or Legal Nurse Consultant Certified (LNCC) preferred upon hire

Preferred BSN or MSN degree

Create a job alert for this search

Licensed Clinical • Hialeah, Florida, United States

Related jobs
  • Promoted
  • New!
Florida Licensed Transitional Care Coordinator

Florida Licensed Transitional Care Coordinator

VirtualVocationsHialeah, Florida, United States
Full-time
A company is looking for a Transitional Care Coordinator LPN.Key Responsibilities Oversee post-acute care utilization and monitor length of stay in skilled nursing facilities Coordinate discharg...Show moreLast updated: 11 hours ago
  • Promoted
  • New!
New Jersey Licensed Memory Care Coordinator

New Jersey Licensed Memory Care Coordinator

VirtualVocationsHialeah, Florida, United States
Full-time
A company is looking for a Memory Care Coordinator (Hybrid).Key Responsibilities Coordinate care and support for caregivers, developing individualized care plans and connecting them to resources ...Show moreLast updated: 17 hours ago
  • Promoted
Licensed Care Management Nurse / Social Worker

Licensed Care Management Nurse / Social Worker

VirtualVocationsTamarac, Florida, United States
Full-time
A company is looking for a Care Management Nurse or Social Worker.Key Responsibilities Collect and assess in-depth information about member situations to identify needs and develop specific care ...Show moreLast updated: 14 days ago
  • Promoted
  • New!
Remote Patient Advocate

Remote Patient Advocate

VirtualVocationsDavie, Florida, United States
Remote
Full-time
A company is looking for a Women's Health Outbound Patient Advocate (Remote).Key Responsibilities Coordinate testing services by communicating with up to 50 patients and healthcare providers dail...Show moreLast updated: 15 hours ago
  • Promoted
RN Appeals Nurse Consultant

RN Appeals Nurse Consultant

VirtualVocationsHialeah, Florida, United States
Full-time
A company is looking for an Appeals Nurse Consultant.Key Responsibilities Process medical necessity appeals for Medicare Part C from members and providers Collaborate with internal and external ...Show moreLast updated: 30+ days ago
  • Promoted
Infusion Advanced Practice Provider

Infusion Advanced Practice Provider

HealthEcareers - ClientHollywood, FL, USA
Full-time
The Division of Hematology / Oncology at Memorial Cancer Institute is seeking a motivated and dynamic Nurse Practitioner (APRN) to join its team in a brand‐new and innovative role.This position offer...Show moreLast updated: 25 days ago
  • Promoted
  • New!
Missouri Licensed Behavioral Health Case Manager

Missouri Licensed Behavioral Health Case Manager

VirtualVocationsPompano Beach, Florida, United States
Full-time
A company is looking for a Behavioral Health Case Manager to provide support and advocacy for members with mental health conditions. Key Responsibilities Facilitate member education and caregiver ...Show moreLast updated: 19 hours ago
  • Promoted
  • New!
LA Licensed Clinical Review Nurse

LA Licensed Clinical Review Nurse

VirtualVocationsTamarac, Florida, United States
Full-time
A company is looking for a Clinical Review Nurse - Concurrent Review.Key Responsibilities Perform concurrent reviews to determine overall health and appropriate level of care for members Review ...Show moreLast updated: 21 hours ago
  • Promoted
Primary Care Opportunity

Primary Care Opportunity

Trinity HealthFort Lauderdale, US
Full-time
Holy Cross Medical Group is currently seeking board certified or board eligible Family Medicine, Internal Medicine, or Med-Peds physicians to join our established and new outpatient Primary Care pr...Show moreLast updated: 30+ days ago
  • Promoted
  • New!
State Licensed Utilization Review Nurse

State Licensed Utilization Review Nurse

VirtualVocationsHollywood, Florida, United States
Full-time
A company is looking for a Utilization Review Nurse (PRN).Key Responsibilities Review and evaluate electronic medical records for emergency admissions to assess medical necessity Apply clinical ...Show moreLast updated: 13 hours ago
  • Promoted
Non-Clinical Case Manager

Non-Clinical Case Manager

VirtualVocationsMiami, Florida, United States
Full-time
A company is looking for a Non-Clinical Case Manager to provide patient support remotely during the hours of 11-8p EST, M-F. Key Responsibilities Provide virtual support to patients, case managers...Show moreLast updated: 30+ days ago
  • Promoted
Primary Care Opportunity

Primary Care Opportunity

HealthEcareers - ClientFort Lauderdale, FL, USA
Full-time
Holy Cross Medical Group is currently seeking board certified or board eligible Family Medicine, Internal Medicine, or Med-Peds physicians to join our established and new outpatient Primary Care pr...Show moreLast updated: 30+ days ago
  • Promoted
California Licensed Review Nurse

California Licensed Review Nurse

VirtualVocationsHialeah, Florida, United States
Full-time
A company is looking for a Pre-Service Review Nurse RN to work remotely in the Pacific or Mountain Time Zones.Key Responsibilities Conduct utilization management, including Prior Authorization Re...Show moreLast updated: 1 day ago
  • Promoted
  • New!
Multi-State Licensed Medical Provider

Multi-State Licensed Medical Provider

VirtualVocationsMiami, Florida, United States
Full-time
A company is looking for a Medical Advanced Practice Provider - On-Call Telehealth.Key Responsibilities Admit new patients remotely and perform medication reconciliation Provide clinical decisio...Show moreLast updated: 19 hours ago
  • Promoted
  • New!
Behavioral Health Appeals Clinician

Behavioral Health Appeals Clinician

VirtualVocationsMiami, Florida, United States
Full-time
A company is looking for a Clinical Review Clinician Appeals - Behavioral Health.Key Responsibilities Performs clinical reviews to resolve and process appeals by analyzing medical records and cli...Show moreLast updated: 13 hours ago
  • Promoted
Care Coordinator

Care Coordinator

VirtualVocationsTamarac, Florida, United States
Full-time
A company is looking for a Care Coordinator in the Mountain Time Zone.Key Responsibilities Engage and enroll patients through telephonic outreach, serving as their primary contact Develop and im...Show moreLast updated: 30+ days ago
  • Promoted
Nurse Practitioner (NP) - Family Practice in Stuart, FL

Nurse Practitioner (NP) - Family Practice in Stuart, FL

LocumJobsOnlineMiami, Florida, US
Full-time +1
LocumJobsOnline is working with CompHealth to find a qualified Family Practice NP in Stuart, Florida, 34994!.Our client, located in St Lucie County, is seeking Advanced Practice Providers to add to...Show moreLast updated: 30+ days ago
  • Promoted
Telephonic Nurse Case Manager

Telephonic Nurse Case Manager

AmTrust FinancialBoca Raton, FL, United States
Full-time
US-TX-Dallas | US-GA-Alpharetta | US-FL-Boca Raton | US-FL-Maitland.AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic Medical Case Manager, RN.To ...Show moreLast updated: 30+ days ago
  • Promoted
Patient Engagement Advocate

Patient Engagement Advocate

VirtualVocationsTamarac, Florida, United States
Full-time
A company is looking for a Patient Engagement Center Advocate.Key Responsibilities Respond to incoming phone calls and schedule patient appointments in the EMR system Document patient requests a...Show moreLast updated: 30+ days ago
  • Promoted
  • New!
Virginia Licensed Nurse Practitioner

Virginia Licensed Nurse Practitioner

VirtualVocationsPompano Beach, Florida, United States
Full-time
A company is looking for a Nurse Practitioner to provide primary health care services for students, focusing on health promotion and disease prevention. Key Responsibilities Provide primary health...Show moreLast updated: 7 hours ago