- Centene Corporation (Sacramento, CA)
- …UM Experience. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… 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...- Licensed Vocational Nurse required or + RN - Registered Nurse -… more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... with dynamic goals resulting in the full and fair review of appeals and designed to achieve...and utilization management, and systems software used in processing appeals . + Knowledge and understanding of medical … more
- VNS Health (Manhattan, NY)
- …Do + Responsible for direct oversight and the day to day management of clinical appeals review processes within Appeals & Grievances Department. + Manages ... Health Plans is seeking a dedicated Manager, Grievance and Appeals ( RN )to lead the daily operations of...of care concerns and any other inquires requiring clinical review for medical necessity, appropriateness of service… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- … Appeals Nurse Reviewer is responsible for reviewing provider claims appeals , validating coding and medical necessity of the services submitted and ... strong clinical and medical coding skills to review provider claim appeals for medical... necessity determinations and billing practices. Key Qualifications: + Registered Nurse with certified coding experience and… more
- R1 RCM (Salt Lake City, UT)
- …orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to draft appeals of denied and underpaid ... experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical...external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + An active CCS,… more
- CDPHP (Albany, NY)
- …Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations ... will be responsible for tracking, trending and monitoring of appeals , grievances, NYS external review , and making...review , and making recommendations for change. QUALIFICATIONS: + Registered Nurse , Physician Assistant or Nurse… more
- Nuvance Health (Danbury, CT)
- …in nursing, health administration, or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience ... leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical...medical necessity outreach, and feedback to the utilization review team on denial outcomes. * *Discharge Planning &… more
- Ascension Health (Wamego, KS)
- …rules and regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Kansas Board of Nursing ... cases. + Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals . +… more
- CareFirst (Baltimore, MD)
- …people. **QUAIFICATIONS:** **Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor ( RN ) directs and coordinates...similar clinical experience OR + 5 years experience in Medical Review , Utilization Management or Case Management… 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
- 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: ... Orientation Program + Paid Time Off (PTO) + Extended Illness Days (EID) + Medical , Dental, and Vision Insurance + Prescription Coverage + Life Insurance + Short and… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4762850) Apply CDOC Registered Nurse ( Nurse ... + Benefits + Questions Department Information *Waiver is in place for the Registered Nurse license requirement: Employment is contingent upon valid licensure as… more
- State of Colorado (Sterling, CO)
- CDOC Registered Nurse - Part-time - Sterling Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4756062) Apply CDOC Registered Nurse ... and staff instruction; + Assists physicians, physician assistants, and nurse practitioners with minor medical and surgical...Applicant must possess a current, valid license as a Registered Nurse from the Colorado Board of… 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...interviewing patients and assisting them in follow-up care; maintaining medical and medication supplies; rendering emergency medical … more
- Sacramento County (Sacramento, CA)
- Supervising Registered Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448883) Apply Supervising Registered Nurse ... 5:00 pm on: 12/2/24, 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… more
- Elevance Health (Palo Alto, CA)
- ** Nurse Appeals - Licensed RN ...+ Extrapolates and summarizes medical information for medical director, consultants and other external review . + ... locations. **Shift:** Monday to Friday from 8:00am-5:00pm **PST** The ** Nurse Appeals ** is responsible for investigating and processing medical necessity … more
- Trinity Health (Philadelphia, PA)
- …as related to the clinical review and level of care. Management of all review and appeals utilizing a modified approach based on specific needs of the ... member of Trinity Health Mid-Atlantic, is seeking experienced Utilization Management RN to join the Case Management team! **Schedule:** Full-time, 40hrs/wk,… 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
- Healthfirst (NY)
- …productivity and quality for each Specialist against expectations + Prepare cases for Medical Director Review ensuring that all pertinent information (ie case ... + Bachelors degree + Experience in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization… more