- BroadPath Healthcare Solutions (Tucson, AZ)
- …BroadPath is seeking a highly motivated and results-driven **UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical ... to enhance understanding of criteria application, benefit use, and the appeal, External Medical Review (EMR), and Fair Hearing processes + Coordinate: Ensures… more
- Alameda Health System (Oakland, CA)
- …background. Required Licenses/Certifications : Valid license to practice as a Registered Nurse in the State of California. Preferred Licenses/Certifications ... the development and implementation of quality improvement initiatives. Oversees the secondary review process; actively appeals denied cases when necessary and… more
- St. Luke's University Health Network (Allentown, PA)
- …ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- Adecco US, Inc. (Minneapolis, MN)
- Adecco Healthcare & Life Sciences is hiring remote RN Appeals Reviewers! This role is remote / work from home. Please read below and apply with an updated resume ... **Pay:** $40.50 to $42.50 an hour **Responsibilities of the RN Appeals Reviewer:** . Responsible for conducting...and Holiday pay upon meeting eligibility criteria. **IMPORTANT:** This ** Registered Nurse ** role is being recruited for… more
- Centene Corporation (Salem, OR)
- …State and NCQA requirements. + Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of ... **Position Purpose:** Act as the liaison for all statewide appeals , fair hearings, review organizations, and other...NCQA standards. + Maintain files and logs for all appeals + Coordinate with Medical Director(s) to… more
- Molina Healthcare (NE)
- …**Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with ... Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals ...RN license is required. **Job Duties** + Facilitates clinical/ medical reviews of retrospective medical claim reviews,… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse ( RN ) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances ... + Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and… 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
- State of Colorado (Grand Junction, CO)
- Registered Nurse I, RN I - Grand Mesa Youth Services Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5157862) Apply ... Registered Nurse I, RN I...practice. Obtains laboratory and other diagnostic procedures ordered by medical providers, review results and notify provider… more
- LA Care Health Plan (Los Angeles, CA)
- …the ability to manage multiple training initiatives simultaneously. Licenses/Certifications Required Licensed Registered Nurse ( RN ) - Active, current and ... Lead Customer Solution Center Appeals and Grievances RN Job Category:...clinical unit. This position is responsible for the quality review of complex and/or escalated clinical A&G cases for… more
- Elevance Health (Mason, OH)
- …on regulatory cases, including ensuring accurate entry, investigation, and analysis of state appeals ; summarizing medical information for review by ... ** Nurse Appeals -Licensed Nurse **...executive leadership by managing State Fair Hearing and External Medical Review requests. .Acts as a resource… more
- Molina Healthcare (Orem, UT)
- For this position we are seeking a ( RN ) Registered Nurse who...Looking for a RN with experience with appeals , claims review , and medical ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… more
- Elevance Health (Columbus, OH)
- ** Nurse Appeals RN ** **Location** : Ohio-Cincinnati, Columbus, Mason, or Seven Fields _(Must be within commutable distance to the listed locations.)_ ... an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and...+ Extrapolates and summarizes medical information for medical director, consultants and other external review .… more
- CommonSpirit Health (Centennial, CO)
- …Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive experience in utilization ... flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as...as indicated through research and coordination of completion of medical records and utilization review processes. Identifies… more
- Elevance Health (Tampa, FL)
- ** Nurse Appeals ** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and...+ Extrapolates and summarizes medical information for medical director, consultants and other external review .… 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 ... 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: 12/1/25, 2/2/26, 4/6/26, 6/1/26, 8/3/26, 10/5/26, 12/7/26 Supervising Registered Nurse - Detention/Correctional Facility is the first level… more
- State of Colorado (Pueblo, CO)
- Registered Nurse I - Nursing Residency Program - CMHHIP - Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5145740) Apply ... Registered Nurse I - Nursing Residency Program...and therapeutic setting for patients with both psychiatric and medical issues. The services provided include evaluation and treatment… more
- Nuvance Health (Danbury, CT)
- …percentage of charge reimbursement payers. * If concurrent inpatient case does not meet medical necessity review criteria during the first level review , ... REQUIRED* * *Hybrid/Remote* * *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within… more
