• Customer Solution Center Appeals

    LA Care Health Plan (Los Angeles, CA)
    …The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse ( RN ) II provides direct assistance to member's with ... Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category:...agencies. Good working knowledge of regulatory requirements/standards. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
    LA Care Health Plan (10/11/24)
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  • Supervisor, Appeals and Grievances Clinical…

    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
    LA Care Health Plan (09/20/24)
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  • Case Manager (CM) - Registered Nurse

    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
    Select Medical (10/10/24)
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  • RN Registered Nurse

    Ascension Health (Manhattan, KS)
    …rules and regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Kansas Board of Nursing ... related to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals . + Assess and coordinate discharge planning needs with… more
    Ascension Health (09/13/24)
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  • Manager, Grievance and Appeals , RN

    VNS Health (Manhattan, NY)
    …Licenses and Certifications: + License and current registration to practice as a registered professional nurse in New York State required Education: + ... to day activities for staff handling of grievances and appeals for one of the following VNS Health Plans...subcontractors who have delegated responsibility for managing grievance and appeals on behalf of the plan to ensure operational… more
    VNS Health (09/04/24)
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  • Nurse Appeals ( RN )

    Elevance Health (Los Angeles, 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
    Elevance Health (11/02/24)
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  • Outpatient Denial/ Appeals Specialist-…

    Carle (Urbana, IL)
    …Work Location: Working from Home + Weekend Requirements: no + Other Posting Information: Registered Professional Nurse ( RN ) License Illinois upon hire. + ... Outpatient Denial/ Appeals Specialist- RN + Department: Revenue...REQUIREMENTS Bachelor's Degree in Nursing CERTIFICATION & LICENSURE REQUIREMENTS Registered Professional Nurse ( RN ) License… more
    Carle (08/23/24)
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  • Registered Nurse D/CF (Level I/II)

    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
    Sacramento County (10/22/24)
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  • Supervising Registered Nurse D/CF

    Sacramento County (Sacramento, CA)
    Supervising Registered Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448883) Apply  Supervising Registered Nurse ... at 5:00 pm on: 6/3/24, 8/5/24, 10/7/24, 12/2/24 Supervising Registered Nurse - Detention/Correctional Facility is the...Document Required with Application: All applicants MUST record their RN license type, number, and expiration date in the… more
    Sacramento County (10/22/24)
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  • Registered Nurse Ortho Med Trauma

    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
    Intermountain Health (11/02/24)
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  • RN Clinical Review Clinician…

    Centene Corporation (Sacramento, CA)
    …on workplace flexibility. This fully remote position requires a California Licensed RN . **Position Purpose:** Performs clinical reviews needed to resolve and process ... appeals by reviewing medical records and clinical data to...processes preferred. **License/Certification:** + For Health Net of California: RN license required Pay Range: $25.97 - $46.68 per… more
    Centene Corporation (10/23/24)
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  • Clinical Appeals , RN , Remote

    RWJBarnabas Health (Oceanport, NJ)
    Clinical Appeals , RN , RemoteReq #:0000173624 Category:Billing/Collections/Registration Status:Full-Time Shift:Day Facility:RWJBarnabas Health Corporate Services ... Services division is an integral part of our company's success. The RN of Appeals within the RWJ Barnabas healthcare facilities is responsible for managing… more
    RWJBarnabas Health (10/30/24)
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  • RN - Grievance and Appeals Clinical…

    Centers Plan for Healthy Living (Margate, FL)
    RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, October 7, 2024 Centers Plan for Healthy Living's goal is ... Reviewer will handle expedited and standard requests and ensures that the appeals are processed in accordance with regulations, compliance standards and policy and… more
    Centers Plan for Healthy Living (10/08/24)
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  • Registered Nurse III- Fort Logan…

    State of Colorado (Denver County, CO)
    Registered Nurse III- Fort Logan **$25,000...and other disciplines + Directs and consults with other RN III's and subordinate staff in their provision of ... Sign On Incentive** Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4708493) Apply  Registered Nurse III- Fort Logan **$25,000 Sign On… more
    State of Colorado (10/29/24)
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  • Registered Nurse - Care Coordinator…

    CareOregon (Medford, OR)
    RN license in the State of Oregon + Minimum 2 year experience as a Registered Nurse ( RN ) in the healthcare industry + Valid driver's license, acceptable ... and must comply with all federal laws. Job Title Registered Nurse - Care Coordinator (Community) Exemption...For Service program benefits). + Report member complaints to Appeals and Grievance team for investigation and follow-up, per… more
    CareOregon (09/27/24)
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  • Registered Nurse [Training Program]…

    City and County of San Francisco (San Francisco, CA)
    …range of mental health and substance use treatment services. The purpose of the 2320 Registered Nurse Training Programs is to prepare registered nurses at ... By applying to this job ad for the 2320 Registered Nurse Training Programs, you will automatically... License (**IMPORTANT: Be sure to include your California RN license number in the application, as failure to… more
    City and County of San Francisco (10/29/24)
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  • Registered Nurse Assessment…

    Wesley Enhanced Living (Philadelphia, PA)
    …in the Nation as a Best Workplace in our industry! Hiring Immediately! The Registered Nurse Assessment Coordinator (RNAC) provides for the initial assessment and ... and implement and update resident Plan of Care. The Registered Nurse Assessment Coordinator (RNAC) would: +...appropriate payers. This includes overseeing UMR reviews and any appeals processes. + Take joint ownership of care conferences… more
    Wesley Enhanced Living (10/01/24)
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  • Supervisor Registered Nurse Case…

    HCA Healthcare (Houston, TX)
    …appropriate. **What qualifications you will need:** + Bachelor's degree Nursing preferred + Registered Nurse - Currently licensed as a registered ... healthcare provider. We are seeking a(an) Case Management Supervisor RN to join our healthcare family. **Benefits** Texas Orthopedic...Support + Registered Social Worker (RSW), or Registered Nurse , or Certified Care Manager (CMC)… more
    HCA Healthcare (08/28/24)
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