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Registered Nurse – Intake

TechDigital Corporation

Remote • Today

Easy Apply

Contract

Depends on Experience

Registered Nurse (RN) – Clinical Appeals & Intake Specialist

Digitive LLC

Remote • Today

Easy Apply

Third Party, Contract

Depends on Experience

Job Details

Skills

Medicaid
Medicare
Quality Assurance

Summary

Job Reponsibilities:
• Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards.
• Prepares case reviews for Medical Directors by researching the appeal, reviewing applicable criteria, and analyzing the basis for the appeal
• Ensures timely review, processing, and response to appeal in accordance with State, Federal and NCQA standards
• Communicates with members, providers, facilities, and other departments regarding appeals requests
• Generates appropriate appeals resolution communication and reporting for the member and provider in accordance with company policies, State, Federal and NCQA standards
• Works with leadership to increase the consistency, efficiency, and appropriateness of responses of all appeals requests
• Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry best practices
• Performs other duties as assigned.
• Complies with all policies and standards.

Must have Skills:
• Requires a degree from an Accredited School of Nursing or Master's degree in Behavioral Health or Social Work and 2 – 4 years of related experience.
• Knowledge of NCQA, Medicare and Medicaid regulations preferred.
• Knowledge of utilization management processes preferred.

License/Certification:
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required or
• LCSW- License Clinical Social Worker required or
• LMHC-Licensed Mental Health Counselor required or
• LPC-Licensed Professional Counselor required or
• Licensed Marital and Family Therapist (LMFT) required or
• Licensed Psychologist required

For Health Net of California: RN license required

Additional information:
Work schedule: Monday to Friday 8 to 5 pm CST

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 10300434
Position Id: 9139582
Posted 22 hours ago

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Contact the job poster

Jayasree Manjunathan

Recruiter @ TechDigital Corporation

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Remote

•

Today

Job Title: Registered Nurse Intake Location: Remote Duration: Through March 2027 Work Authorization: W2 only (no subcontracting) For California-based roles: RN license required Job Responsibilities: Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. Prepares case reviews for Me

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Third Party, Contract

Depends on Experience

Clinical Document Improvement Coordinator

Remote

•

Yesterday

Duration: 6 months Job Description The CDI Coordinator serves as an experienced second-level CDI reviewer and subject matter expert, managing work queues and performing post-coding/pre-bill reviews. Responsibilities include reviewing audit recommendations, determining query validity, issuing follow-up queries, and providing guidance and education to the CDI team on complex coding, query, and procedure-coding questions. Qualifications: Minimum 3 years of CDI experience, current CDI certificatio

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Contract

47 - 57

Claims Attorney: French and English Bilingual

Remote

•

Yesterday

Claims Attorney: French and English Bilingual Location: Beaverton, OR 97005 or Remote Approved Remote Locations: AZ, DC, FL, IL, KS, MO, NY, NC, OH, OR, TN, MD, NJ, SC, AL, CO, CT, DE, GA, ID, IN, KY, LA, MA, MI, MN, NV, OK, PA, TX, UT, WI Employment Type: 6+ Month W2 Contract C2C and Sponsorship: Not Available Overview Talent Groups is seeking bilingual Claims Contract Attorneys to support a large scale legal claims administration project involving product liability class action litigation and

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Contract

35 - 40

EPIC Willow Application Analyst (100% REMOTE/NO C2C)

Remote

•

Today

Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplished EPIC Willow Application Analyst. NOTE- THIS IS 100% REMOTE ROLE & ONLY W2 CANDIDATES NO C2C/1099 Candidate must be authorized to work in USA without requiring sponsorship Position: EPIC Willow Application Analyst (Job Id 055) Location: San Francisco CA 94104 (100% REMOTE) Duration: 6 Months + Possible Extension Job Fun

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Contract

95 - 100