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Per Diem-Anesthesiologist
WMCHealth

Kingston, New York

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STAR+PLUS Appeals Nurse RN
Harris Health System

Houston, Texas

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Pediatric Endocrinologist
Lee Health

Fort Myers, Florida

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Registered Nurse RN Home Health
AdventHealth

Sebring, Florida

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Medical Director - Emergency Medicine - Baptist (Homestead, FL)
Nicklaus Children’s Health System

Homestead, Florida

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Pediatric Adolescent Medicine - Office Physician
Lee Health

Fort Myers, Florida

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Inpatient RN Care Coordinator I - DAY SHIFT - Care Transitions
Penn State Health

Hershey, Pennsylvania

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Crisis Assessment Specialist Part Time Evenings
AdventHealth

Denver, Colorado

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Utilization Management Nurse II - Case Management - Full Time
CHRISTUS Health

Longview, Texas

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Registered Nurse Neurology
AdventHealth

Ocala, Florida

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Quality HEDIS, RN
Harris Health System

Houston, Texas

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Primary Care Medical Director Care Access Solutions, Nurse Connect, Technology/Quality Improvement
UNC Health

Morrisville, North Carolina

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Internal Medicine Outpatient
Baylor Scott & White Health

Waco, Texas

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Adult Oncology/Hematology Physician
Lee Health

Fort Myers, Florida

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Registered Nurse RN Home Health
AdventHealth

Sebring, Florida

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Anesthesiologist
WMCHealth

Kingston, New York

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Physical Therapist PT Home Health
AdventHealth

Brooksville, Florida

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STAR+PLUS Appeals Nurse RN
Harris Health System

Houston, Texas

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Registered Nurse Critical Care ICU Medical Nights
AdventHealth

Ocala, Florida

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Registered Nurse RN Home Health
AdventHealth

Brooksville, Florida

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Primary Care Opportunities in Shelby County, AL
Orlando Health

Alabaster, Alabama

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Psychiatrist - Addiction Treatment
WMCHealth

Poughkeepsie, New York

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Breast Surgery (Oncology) Physician
Lee Health

Fort Myers, Florida

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Physician - Hospice and Palliative Care Director (Martinez)
Veterans Affairs, Veterans Health Administration

Martinez, California

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Physical Therapist PT Home Health
AdventHealth

Dade City, Florida

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STAR+PLUS Appeals Nurse RN
JOB SUMMARYSTAR +PLUS Appeals Nurse assists in the review of medical records submitted for appeals by providers due to adverse determination. Utilize evidence-based criteria, regulatory guidelines and Medical Affairs departmental policies for medical necessity and level of care determination. Provides written response of the outcome of the appeals finding to the appealing provider and member. Assists in the ongoing development and maintenance of a database for tracking, trending and reporting appeals cases.JOB SPECIFICATIONS AND CORE COMPETENCIESEssential FunctionsReviews and provides resolution of STAR+PLUS Appeals, per regulatory guidelines to providers for c


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