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Shannon Health

San Angelo, Texas

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Veterans Affairs, Veterans Health Administration

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Kadlec

Richland, Washington

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MultiCare Health System

Spokane, Washington

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Spokane, Washington, Washington

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Bee Cave, Texas

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Providence

Walla Walla, Washington

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Downey, California

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Summit Health, Part of VillageMD

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Columbus, Nebraska

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Summit Health, Part of VillageMD

Mesa, Arizona

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Kindred Hospitals

Seattle, Washington

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CHRISTUS Health

Tyler, Texas

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Tavares, Florida

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Leavenworth, Kansas, Kansas

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AdventHealth

Hinsdale, Illinois

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CommonSpirit Health Mountain Region

Durango, Colorado

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MultiCare Health System

Puyallup, Washington

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Kindred Hospitals

Westminster, California

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Appeals and Grievance Nurse Registered Nurse II PRN
DescriptionSummary:Responsible for the management and communication of denials/appeals received from third party payers, managed care companies, and/or government entities/auditors related to medical necessity and/or level of care. This associate will be a liaison and point of contact for clinical denials and appeal inquiries. The Clinical Appeals Nurse will review each case identified/referred for appeal based on Milliman Care Guidelines (MCG), InterQual, and/or other relevant guidelines, determined the viability of the appeal, and manage the appeal process. The Clinical Appeals Nurse is responsible for appealing all inappropriate denials through all possible levels of the appeal process. The RN Clinical Appeals Nurse will actively manage, main


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