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Northern Light Health Logo
Practice Urology at a Stable Practice in Maine
Northern Light Health

Presque Isle, Maine

Featured! NEW!
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Non-Invasive Cardiologist - Northern Region
WMCHealth

Kingston, New York

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Medical Director, Complex Care
Nemours

Jacksonville, Florida

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Registered Nurse RN Home Health
AdventHealth

Deland, Florida

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Lee Health Logo
Adult Oncology/Hematology Physician
Lee Health

Fort Myers, Florida

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CHRISTUS Health Logo
Registration Representative / Full-time
CHRISTUS Health

Santa Fe, New Mexico

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CHRISTUS Health Logo
LVN, Licensed Vocational Nurse Clinic - Specialty Orthopedic Surgery - Full Time
CHRISTUS Health

Texarkana, Texas

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WMCHealth Logo
Pediatric Inpatient Hospitalist
WMCHealth

Poughkeepsie, New York

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AdventHealth Logo
Speech Language Pathologist Care Manager PRN Home health
AdventHealth

Manchester, Kentucky

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Veterans Affairs, Veterans Health Administration Logo
Physician - Medical Director Primary Care
Veterans Affairs, Veterans Health Administration

Boston, Massachusetts

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CHRISTUS Health Logo
Care Manager II - Case Management
CHRISTUS Health

Corpus Christi, Texas

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CHRISTUS Health Logo
Risk Adjustment Education Specialist-Health Plan Admin
CHRISTUS Health

Irving, Texas

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CHRISTUS Health Logo
Care Manager II - Case Management
CHRISTUS Health

Alamogordo, New Mexico

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AdventHealth Logo
Connected Care Coordinator Registered Nurse Home Health
AdventHealth

Altamonte Springs, Florida

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WMCHealth Logo
Hematologist/Oncologist
WMCHealth

Hawthorne, New York

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BJC HealthCare Logo
Pediatrician-Join successful group and Care for Kids, in Farmington, MO
BJC HealthCare

Farmington, Missouri

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Nemours Logo
Medical Director, Health and Transition Services
Nemours

Jacksonville, Florida

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AdventHealth Logo
Registered Nurse RN Home Health
AdventHealth

Palm Coast, Florida

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Orlando Health Logo
Exciting Opportunity for a Neurologist in Alabama
Orlando Health

Birmingham, Alabama

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CHRISTUS Health Logo
Medical Office Specialist Float Pool/Full-Time
CHRISTUS Health

Santa Fe, New Mexico

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Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment (Hybrid)
UCLA

Los Angeles, California

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Indiana University Health Logo
Registered Nurse-Outpatient Triage-Primary Care-Downtown Indianapolis
Indiana University Health

Indianapolis, Indiana

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CHRISTUS Health Logo
Physician - Physician Advisor
CHRISTUS Health

Longview, Texas

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AdventHealth Logo
Registered Nurse Critical Care Float
AdventHealth

Ocala, Florida

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AdventHealth Logo
Registered Nurse RN Home Health
AdventHealth

Tarpon Springs, 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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