- Elevance Health (Palo Alto, 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
- 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
- R1 RCM (Salt Lake City, UT)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical ... what you will 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
- UCLA Health (Los Angeles, CA)
- Description As the Appeals & Grievances Nurse , you will play a key role in managing and resolving New Century Health Plan member appeals and grievances. You ... BSN or MSN degree, required * Current valid California RN license, required * Minimum of 2 years' experience...Advantage setting is highly desired * Experience in handling appeals , grievances, utilization management, or potential quality issues *… 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
- 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
- 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
- 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
- Cleveland Clinic (Weston, FL)
- …from an accredited school of professional nursing. + Current state licensure as a Registered Nurse ( RN ). + Basic Life Support (BLS) certification through ... information to payers, UM data collection and reporting, concurrent denials appeals process, clinical team interaction, Physician Adviser interaction and special… more
- State of Colorado (Sterling, CO)
- CDOC Registered Nurse - Part-time - Sterling 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/4756062) Apply CDOC Registered Nurse - Part-time - Sterling Salary...Colorado? If so, what state issued your license? 07 Nurse Licensure Compact: If appointed to an RN… more
- Ascension Health (Wamego, 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
- 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 (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
- 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
- Washington County (Stillwater, MN)
- Registered Nurse Social Services Print (https://www.governmentjobs.com/careers/washingtonmn/jobs/newprint/4799191) Apply Registered Nurse Social ... Benefits + Questions JOB SPECIFICS We currently have one Registered Nurse Social Services position in the...recommendations in county or district court or in administrative appeals hearings; * Advise clients of possible resources, rights… 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...Case Manager Upon Hire Preferred. + LNCC - Legal Nurse Consultant Certified Upon Hire Preferred. **Experience:** + 5… 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
- 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
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... and support NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department. We are looking for an experienced people leader… more
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