- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... the safety net required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily… more
- Elevance Health (Indianapolis, IN)
- ** Nurse Appeals ** **Location: Indiana** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... for employment, unless an accommodation is granted as required by law. The ** Nurse Appeals ** is responsible for investigating and processing and medical… more
- Evolent (Springfield, IL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and electronic ... format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible to develop a… more
- BJC HealthCare (St. Louis, MO)
- …experience) **Additional Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist with infusion appeals for both government ... be handling clinical denials and sending them to a nurse to review and appeal and then they will...clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be able to multi-task and maintain… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and grievance correspondence, and ... collecting, organizing and tracking information to facilitate and expedite processing of appeals and grievances received from a variety of sources. We are looking… more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with the development of a… more
- Centene Corporation (Austin, TX)
- …day** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical ... + Communicates with members, providers, facilities, and other departments regarding appeals requests + Generates appropriate appeals resolution communication and… more
- CareFirst (Baltimore, MD)
- …& Qualifications** **PURPOSE:** We are looking for a Director, Medical Review & Appeals for our Government Programs lines of business. The incumbent will ensure ... through direction and oversight of the Clinical Medical Claims Reviews, Clinical Appeals and Analysis programs and Quality of Care complaints in conjunction with… more
- St. Luke's University Health Network (Allentown, PA)
- …a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... APR-DRG for the purpose of appealing proposed DRG and coding changes by insurance providers or their respective auditors JOB DUTIES AND RESPONSIBILITIES: + Conduct… more
- State of Indiana (Indianapolis, IN)
- Appeals & Eligibility Specialist Date Posted: Oct 16,...requirements at 42 CFR 483.430, or - A registered nurse in Good Standing with the State of Indiana ... holidays, 14 on election years + Education Reimbursement Program + Group life insurance + Referral Bonus program + Employee assistance program that allows for… more
- State of Colorado (Pueblo, CO)
- NURSE III - Clinical Specialist - Pueblo Regional...if your application is eliminated. You will find the appeals process, the official appeal form, and how to ... Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5186234) Apply NURSE III - Clinical Specialist - Pueblo Regional Center Salary… more
- State of Colorado (Pueblo, CO)
- LICENSED PRACTICAL NURSE III - CMHHIP - Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5184282) Apply LICENSED PRACTICAL NURSE III ... Description + Benefits + Questions Department Information Licensed Practical Nurse III - Full Time CMHHIP This position will...if your application is eliminated. You will find the appeals process, the official appeal form, and how to… more
- State of Colorado (Denver, CO)
- Charge Nurse RN II - CO Mental Health Hospital in Fort Logan (S. Denver) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5185912) Apply Charge ... Nurse RN II - CO Mental Health Hospital in...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Pueblo, CO)
- Nurse I - Registered Nurse I -...if your application is eliminated. You will find the appeals process, the official appeal form, and how to deliver ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5187654) Apply Nurse I - Registered Nurse I - CMHHIP Salary $43.80 - $61.31 Hourly Location… more
- State of Colorado (Pueblo, CO)
- Registered Nurse II- CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5187078) Apply Registered Nurse II- CMHHIP Salary $45.99 - ... + Description + Benefits + Questions Department Information Registered Nurse II-Full Time CMHHIP This posting will be used...if your application is eliminated. You will find the appeals process, the official appeal form, and how to… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5123731) Apply CDOC Registered Nurse ( Nurse I) ... Monthly Location Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 10/2025 Department Department of Corrections Division Clinical and Correctional… more
- State of Colorado (Denver, CO)
- Nurse Supervisor - Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5180324) Apply Nurse Supervisor - Denver Salary $8,369.00 - ... Location Denver, CO Job Type Full Time Job Number Nurse III 34377 Den 12/2025 Department Department of Corrections...Short and long term disability coverage; + Paid life insurance ; + 11 paid holidays per year plus vacation… more
- State of Colorado (Denver, CO)
- Registered Nurse , Health Compliance Inspector Home Care - FAA00601 (HP III RN) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5183355) Apply ... Registered Nurse , Health Compliance Inspector Home Care - FAA00601 (HP...with optional 401K/457) + Comprehensive medical, dental, and life insurance + Short- and long-term disability coverage + 11… more
- State of Colorado (Garfield County, CO)
- NURSE II - Veteran's Community Living Center at Rifle Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5145886) Apply NURSE II - Veteran's ... & Appeal Rights Education/Licensure/Certification/Experience: Current, valid licensure as a Registered Nurse from the Colorado Board of Nursing or any state… more