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Description The Appeals Nurse examines medical records and claims information for first-level appeal cases to determine whether services provided were medically necessary and meet Medicare coverage guidelines in accordance with Medicare...

Why is Health Advocate a great place to work? For starters, Health Advocate employees enjoy helping people every single day. Employees are given the training they need to do their jobs well, and they work with supervisors and staff who are...

Serious Medicine is what we do. Being extraordinary is who we are. Every colleague plays a key role in upholding this promise to our patients and their families. Shift: First Shift (United States of America)...

Where You'll Work St. Elizabeth Community Hospital provides state-of-the-art health care to the North State communities. This award-winning facility is a member of the Dignity Health system of health care providers and is a...

Salary: $70,779.53 Annually Location : Homebased, GA Job Type: Full-Time Salaried Job Number: 2020-02252 Division: Healthcare Facility Regulation...

Job Profile Summary Position Purpose: nalyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's...

Highlights $65,000 - $85,000 salary based on experience and certifications Consistent schedule M-F, no overnights or weekendsWork with a company that truly cares about their employees and...

Job Description: • Participates in the development and ongoing implementation of QM Work Plan activities. • Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet...

Registered Nurse: Review and Evaluation Are you a registered nurse ready to take your career in an exciting new directionone where your expertise truly makes a difference? Join Pennsylvania's premier Quality Improvement Organization and...

Care Manager Sharecare is the leading digital health company that helps people no matter where they are in their health journey unify and manage all their health in one place. Our comprehensive and data-driven virtual health platform is...

Find your calling at Mercy! Serves as primary liaison between the doctor and patient. Responsible for communicating with patients, assessing and evaluating their needs and advising the patients of the recommended...

A national diversified health organization is seeking a Registered Nurse to develop and manage care plans for members in Connecticut. The role involves evaluating member needs, collaborating with providers, and providing education to members and...

The Case Manager Hybrid I/II will provide case management services to patients and their families or caregivers. Assist with assessment, participate in planning and implementation of intervention and ensure follow-up and coordination of...

Our Company Amerita Overview At Amerita, we're not just delivering Specialty Infusion services-we're building relationships that improve patient outcomes and drive business...

These roles involve patient care, including assessment, diagnosis, treatment, and follow-up. May work across various healthcare settings, such as hospitals, clinics, long-term care facilities, and community health organizations. Responsibilities...

Discover. Achieve. Succeed. #BeHere Location: US:WI:MENOMONEE FALLS at our CP-NORTH HILLS HEALTH CENTER facility. This job is ON - SITE. FTE: 0.400000 Standard...

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach...

Job Title: Clinical Appeals Specialist Duration: 6 months Location: Fully Remote(DMV Area) Type:W2 only Job Description: PURPOSE: The Clinical Appeals Specialist completes research, basic analysis, and...

Company Overview Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our...

Explore Opportunities With Agency Name As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each...

A healthcare organization is looking for a Preservice Review Nurse RN in Boston, Massachusetts. The role involves performing pre-service clinical coverage reviews for Home Health services, ensuring patient access to appropriate care. Successful...

Care Manager Sharecare is the leading digital health company that helps people unify and manage all their health in one place. Our comprehensive and data-driven virtual health platform is designed to help people, providers, employers,...

You Belong Here. At MultiCare, we strive to offer a true sense of belonging for all our employees. Across our health care network, you will find a dynamic range of meaningful careers, opportunities for growth, safe workplaces, and...