Top 12 Rn navigator remote Jobs in North Dakota

Clinical Appeals Coordinator
Trillium Community Health Plan —North Dakota
- $33.71 - $60.67 an hour
- Full-time
- Remote
- Nursing
- LVN
- RN License
- Paid holidays
- Health insurance
2d
RN Readmission Manager, Payment Integrity
Centene Corporation —North Dakota
- $87,700 - $157,800 a year
- Full-time
- Remote
- Nursing
- RN License
- 3 years
- Paid holidays
- Health insurance
11d
Quality Practice Liaison (Must be licensed in Arizona or Multi-State)
CVS Health —North Dakota
- $54,095 - $155,538 a year
- Full-time
- Remote
- Nursing
- Microsoft Outlook
- RN License
- Health insurance
- Dental insurance
11d
RN Ambulatory, Triage – Endoscopy Education (Remote – Must Reside Near Fargo, ND)
Sanford Health —Fargo, ND
- $29.50 - $44.50 an hour
- 8 hour shift
- Remote
- Background check
- Nursing
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
3d

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Clinical Appeals Coordinator
Trillium Community Health Plan —North Dakota
License/Certification: LPN, LVN, or RN license. Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock…
$33.71 - $60.67 an hour
2d
Quality Practice Liaison (Must be licensed in Arizona or Multi-State)
CVS Health —North Dakota
Active and unrestricted Arizona or compact state RN (Registered Nurse) license. Willingness to travel in the state of Arizona up to 10% of time, if commutable.
$54,095 - $155,538 a year
11d

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Care Manager (RN)
Axelon Services Corporation —Ohio
Provide high-quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.
$48.35 an hour
Quick Apply
Registered Nurse (Ohio)
Tuesday Health —Columbus, OH
Valid driver's license with safe driving record. Active and unrestricted Registered Nurse license in the State of Ohio without any board action.
Quick Apply

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rn navigator remote jobs near north dakota

Clinical Appeals Coordinator

Trillium Community Health Plan -
North Dakota

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Job Details

Full-time
$33.71 - $60.67 an hour
2 days ago

Benefits

Paid holidays
Health insurance
401(k)
Tuition reimbursement
Paid time off

Qualifications

Appeals
Nursing
LVN
Accreditation standards (regulatory compliance area)
RN License
Managed care organization experience
Filing
Mid-level
State healthcare regulations
3 years
Master's degree
Clinical case management
Case appeal in utilization management
Records management
Case review audits
Pre-authorization review for utilization management
Utilization management
Resource utilization in healthcare
LPN
Home health
Insurance claims appeal handling
Nursing

Full Job Description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

RN, LVN/LPN - Licensed in Oregon

Pacific Time Work Hours

Position Purpose:
Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals. Responsible for ensuring that all appeal letters generated comply with both State and NCQA requirements.

Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services requested.
Prepare reviews for cases that did not meet criteria
Gather, analyze and report verbal and written information regarding member and provider clinical appeals, including information follow up
Prepare response letters for member and provider clinical appeals and ensure letters are compliant with State and NCQA standards.
Maintain files and logs for all appeals
Coordinate with Medical Director(s) to clarify medical determinations or clinical rationale
Maintain current knowledge of NCQA and State regulations

Coordinate Fair Hearings with various internal departments and agencies
Performs other duties as assigned
Complies with all policies and standards

Education/Experience:
RN with 4+ years of clinical nursing and/or case management experience or LPN/LVN with 5+ years of clinical nursing or case management experience. Managed care or utilization review experience preferred.

License/Certification: LPN, LVN, or RN license.

Specialty Therapy Requirement: Master’s degree in area of specialty therapy or equivalent experience. 3+ years of experience providing therapy services in healthcare or home health settings. Managed care or utilization review experience preferred.

Pay Range: $33.71 - $60.67 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Apply Now

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rn navigator remote jobs in north dakota

Clinical Appeals Coordinator

RN Readmission Manager, Payment Integrity

Quality Practice Liaison (Must be licensed in Arizona or Multi-State)

RN Ambulatory, Triage – Endoscopy Education (Remote – Must Reside Near Fargo, ND)

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