• Clinical Appeals Supervisor (Hybrid)

    CareFirst (Baltimore, MD)
    …organization or hospital. Demonstrated leadership skills. In Lieu of Education. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or ... more
    CareFirst (03/04/25)
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  • Clinical Appeals Nurse Coder

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    …is eligible for the eWorker persona.The TeamAs an integral part of the Clinical Appeals team, the Appeals Nurse Reviewer will serve as a liaison and ... more
    Blue Cross Blue Shield of Massachusetts (02/13/25)
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  • Clinical Appeals Nurse

    R1 RCM (Chicago, IL)
    …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help our ... more
    R1 RCM (03/26/25)
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  • Clinical Appeals Specialist

    CDPHP (Albany, NY)
    …share these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and ... more
    CDPHP (03/20/25)
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  • Clinical Coding Appeals Supervisor

    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 ... more
    R1 RCM (03/12/25)
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  • Clinical Coding Appeals Nurse

    R1 RCM (Detroit, MI)
    …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help ... more
    R1 RCM (02/19/25)
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  • Clinical Appeals Consultant PRN

    Intermountain Health (Columbus, OH)
    …write up clinical reviews for insurance audits and governmental insurance appeals using supporting documentation. 2. Assesses the appropriateness of clinical ... more
    Intermountain Health (03/27/25)
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  • Supervisor, Appeals and Grievances…

    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 ... more
    LA Care Health Plan (03/20/25)
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  • Manager, Grievance and Appeals , RN

    VNS Health (Manhattan, NY)
    …Will Do + Responsible for direct oversight and the day to day management of clinical appeals review processes within Appeals & Grievances Department. + ... more
    VNS Health (03/05/25)
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  • Clinical Appeals Specialist II…

    Community Health Systems (Franklin, TN)
    **Job Summary** The Appeals Specialist II, under the direction of the Director of Denial Support Services, logs and reviews per documentation guidelines for report ... more
    Community Health Systems (03/26/25)
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  • Appeals and Grievances Clinical…

    Healthfirst (AL)
    …degree + Case management/care management -QOC experience preferred + Experience in clinical practice with experience in appeals & grievances, claims processing, ... more
    Healthfirst (02/22/25)
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  • CHS Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    …named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals ... more
    Catholic Health Services (03/19/25)
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  • CHS Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    …named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals ... more
    Catholic Health Services (02/14/25)
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  • Clinical & Coding Specialist - Senior

    Independent Health (Buffalo, NY)
    …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... more
    Independent Health (01/14/25)
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  • Director of Clinical Denials Management…

    BrightSpring Health Services (Louisville, KY)
    …management. This position will also support detailed level reporting and analytics, clinical appeals , root cause analysis, and address identified trends in ... more
    BrightSpring Health Services (02/21/25)
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  • Medical Policy Clinical Specialist

    Premera Blue Cross (Mountlake Terrace, WA)
    …Technology). (Required) + Registered Nurse , Physician's Assistant, or Nurse Practitioner with five (5) years' clinical experience. (Required) + Four ... more
    Premera Blue Cross (03/04/25)
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  • Appeal Specialist RN

    Rush University Medical Center (Chicago, IL)
    …with Rush policies and procedures. **Other information:** **Required Job Qualifications:** * Licensed, registered nurse in the State of IL with at least 5 ... more
    Rush University Medical Center (03/15/25)
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  • Analyst, Appeals

    ManpowerGroup (Columbia, SC)
    …industry, is seeking an Analyst, Appeals to join their team. As an Analyst, Appeals , you will be part of the clinical review department supporting the ... more
    ManpowerGroup (02/15/25)
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  • RN -Denial Reviewer - remote

    PeaceHealth (Vancouver, WA)
    …clinical DRG-downgrade denials in the inpatient acute care setting Credentials + Required: Registered Nurse In state of practice or + Required: Certified ... more
    PeaceHealth (03/12/25)
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  • Quality Improvement Coordinator - Behavioral…

    Centene Corporation (Tacoma, WA)
    …Administration required. Experience in Behavioral Healthcare field required. Registered Nurse ( RN ), Licensed Clinical Social Worker (LCSW), Licensed ... more
    Centene Corporation (03/29/25)
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