Medicare Appeal Reviewer jobs

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Manager of Utilization Mangement - IL
Meridian Health Plan 38 reviews - Chicago, IL
Conducts inter-rater reliability tests and audits among Nurse Reviewers, Pre-Service Nurse Reviewers, Transitional Case Managers and Utilization Management Care...
Sponsored by Miracle Workers - 22 days ago
Medical Director, Network Management
AmeriHealth Caritas 54 reviews - Baton Rouge, LA
Primary care discipline, and prior experience as an Associate Medical Director (or equivalent) or a physician reviewer in a Managed Care Plan are preferred....
Sponsored by AmeriHealth Caritas - 18 days ago
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Medical Director

Molina Healthcare 129 reviews - San Juan, PR - +4 locations
Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. Evaluates authorization requests in timely support of nurse reviewers and...

Behavioral Health Case Manager I

Anthem, Inc. 555 reviews - Atlanta, GA
May also manage appeals for services denied. Family of companies focused on serving Medicaid, Medicare and uninsured individuals, it's a powerful combination....

Reconsideration Analyst I

TMF Health Quality Institute 5 reviews - Jacksonville, FL
Medicare Part B experience. Basic knowledge of the Medicare program. Receive decisions from ALJs and build ALJ decision files for review by reconsideration...

Medical Director for Medical Claims and Code Edit Review

Molina Healthcare 129 reviews - Long Beach, CA
Evaluates authorization requests in timely support of nurse reviewers and manages the denial process. Current state Medical license without restrictions to...

Utlization Management Reviewer

Pine Rest Christian Mental Health Services 15 reviews - Grand Rapids, MI 49548
Conduct reviews of Medicare admissions to assure stay meets criteria. Remains current on all third party payer requirements for authorization of services and...

Grievance Coordinator

Partnership HealthPlan of California 10 reviews - Fairfield, CA - +1 location
Responsible for coordinating the compilation of appeal case files for transmission to external third-party reviewers, physician reviewers and independent review...

Pt Care Coordinator

Mercy Medical Center 499 reviews - Cedar Rapids, IA
Working knowledge of healthcare insurance, Medicare and Medicaid is preferred. Identifies appropriate cases for appeals, formulates written appeals letters, and...

Business Coordinator II

Novitas Solutions Inc. - Pittsburgh, PA
Medicare program, business writing. Acceptances, tentatives, FDR, LDR, NPRs, reopenings, appeals, etc.). An understanding of the relevant standard/shared and...

Behavioral Health Case Manager Work@Home Houston TX MMP

Anthem, Inc. 555 reviews - Houston, TX - +3 locations
May also manage appeals for services denied. Family of companies, is focused on serving Medicaid, Medicare....

Medical Director

Beth Abraham Family of Health Services - Bronx, NY
Develop / enhance reviewer guidelines for non-clinical and clinical (RN Reviewer) staff Participate in the evaluation of process outcomes with the goal of...

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Company with Medicare Appeal Reviewer jobs
54 reviews
AmeriHealth Caritas is the nation's leader in health care solutions for the underserved and chronically ill for over 30 years.
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