- LA Care Health Plan (Los Angeles, CA)
- …an enthusiastic team player. Must be able to work independently. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017… more
- Walgreens (Deerfield, IL)
- …rare disease states and complex, chronic conditions. \#LI-AJ1 **Job ID:** 1524615BR **Title:** Registered Nurse ( RN ) - Nursing Network (Remote) **Company ... to defined medications. Evaluates all requests for prior authorizations, appeals and accompanying tasks. + Provides nursing network subject...Associate's degree in Nursing + Current license/registration as an RN ( Registered Nurse ) with the… more
- MaineGeneral Health (Waterville, ME)
- …to our patients and their families. MaineGeneral Hospice is currently seeking an experienced Registered Nurse ( RN ) for a 32-40 hour per week position. ... and professional development. The ideal candidate will have: + A current license as a Registered Nurse in Maine or licensed from a compact state required +… more
- VNS Health (Manhattan, NY)
- …complexities of healthcare? VNS Health Plans is seeking a dedicated Manager, Grievance and Appeals ( RN )to lead the daily operations of our grievance and ... appeals processes. You will play a crucial role in...+ License and current registration to practice as a registered professional nurse in New York State… more
- Select Medical (Los Angeles, CA)
- …Medical Century City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) Registered Nurse ( RN ) or Licensed Clinical Social Worker (LCSW) **Pay Rate: ... overseeing negotiations of continued stay rationale, length of stays, and appeals process. Initiates activities to develop positive business relationships with… more
- Elevance Health (Walnut Creek, CA)
- ** Nurse Appeals - Licensed RN Nurse ** **Location:** This position will work in a hybrid model (remote and office). Ideal candidates will live in the ... our PulsePoint locations. **Shift:** Monday to Friday from 8:00am-5:00pm **PST** The ** Nurse Appeals ** is responsible for investigating and processing medical… more
- Molina Healthcare (Columbus, OH)
- … appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of ... interpret these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Compact… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print...RN license. 07 Do you possess an active RN license issued by an Enhanced Nurse Licensure ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4762850) Apply CDOC Registered Nurse ( Nurse I) Salary $7,442.00 Monthly Location Statewide,… more
- State of Colorado (Denver, CO)
- CDOC Registered Nurse - Part-time - Denver Print...Yes + No 06 Do you possess an active RN license issued by an Enhanced Nurse Licensure ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4829308) Apply CDOC Registered Nurse - Part-time - Denver Salary...Colorado? If so, what state issued your license? 07 Nurse Licensure Compact: If appointed to an RN… more
- Sacramento County (Sacramento, CA)
- Supervising Registered Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448883) Apply Supervising Registered Nurse ... are at 5:00 pm on: 2/3/25, 4/7/25, 6/2/25, 8/4/25, 10/6/25, 12/1/25 Supervising Registered Nurse - Detention/Correctional Facility is the first level supervisory… more
- Sacramento County (Sacramento, CA)
- …read and understood the above instructions. 02 Select the one box that best describes your Registered Nurse ( RN ) license issued by the State of California. + ... Registered Nurse D/CF (Level I/II) Print...Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days… more
- Intermountain Health (Billings, MT)
- **Job Description:** The Registered Nurse ( RN ) is a professional caregiver who assumes responsibility and accountability for assessing, planning, ... implementing and evaluating care of patients. The staff RN utilizes the nursing process by use of technology,...and coordination of care with other health team members. ** Registered Nurse Scope Of Practice:** As a… more
- Healthfirst (NY)
- …of the appeal process + Additional duties as assigned Minimum Qualifications: + RN , LPN OR Dental Hygienist Preferred Qualifications: + Bachelors degree + ... Experience in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management/case management. +… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The RoleThe Appeals Nurse Reviewer is responsible for reviewing provider claims appeals , ... eWorker persona.The TeamAs an integral part of the Clinical Appeals team, the Appeals Nurse ...medical necessity determinations and billing practices. Key Qualifications: + Registered Nurse with certified coding experience and… more
- Centene Corporation (Jefferson City, MO)
- …assigned + Complies with all policies and standards ** Registered Nurse with behavioral health and Medicare appeals experience preferred.** ... Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to...- Licensed Vocational Nurse required or + RN - Registered Nurse -… more
- State of Colorado (Denver, CO)
- Registered Nurse I-$14,000 SIGN ON BONUS...of the department's action. For more information about the appeals process, the official appeal form, and how to ... Health Hospital in Fort Logan-Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4822746) Apply Registered Nurse I-$14,000 SIGN ON BONUS Colorado… more
- State of Colorado (Centennial, CO)
- Registered Nurse I - Marvin Foote...of the department's action. For more information about the appeals process, the official appeal form, and how to ... Youth Services Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4819409) Apply Registered Nurse I - Marvin Foote Youth Services… more
- University of Miami (Coral Gables, FL)
- …of MIami/UHealth Department of Ortho Sports Medicine is currently seeking a full time Registered Nurse 1 to work in Coral Gables, FL. The Registered ... CORE QUALIFICATIONS Education:Bachelor of Science in nursing Certification and Licensing: Registered Nurse License; Basic Life Support Certification (BLS)… more
- CareFirst (Baltimore, MD)
- …treatment needs or those with substance disorders and addictions. **Licenses/Certifications** : + RN - Registered Nurse - State Licensure And/or Compact ... will support the government programs line of business. The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider… more
- R1 RCM (Chicago, IL)
- …team members and 1:1 meetings on a routine basis. **Required Skills:** + Active Registered Nurse license + Active AHIMA or AAPC Coding Certification including ... analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Supervisor** , you will support clinical coders and coding team… more
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