• Clinical Appeals Nurse

    CareFirst (Baltimore, MD)
    **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes ... regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes ...**Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse -… more
    CareFirst (11/09/24)
    - Save Job - Related Jobs - Block Source
  • Clinical Coding Appeals Nurse

    R1 RCM (Boise, ID)
    …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** +...external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + **Active AHIMA or… more
    R1 RCM (11/22/24)
    - Save Job - Related Jobs - Block Source
  • Customer Solution Center Appeals

    LA Care Health Plan (Los Angeles, CA)
    Registered Nurses and Medical Directors to appropriately investigate, review and resolve clinical appeals and grievances. Prepares Nurse Summary for MD ... Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical...under the direct supervision and management of the A&G Nurse Specialist, RN and/or Medical Director. This… more
    LA Care Health Plan (11/20/24)
    - Save Job - Related Jobs - Block Source
  • Quality Review Nurse (Remote)

    CareFirst (Baltimore, MD)
    …+ Reviews Clinical Appeals and Grievances documentation written by the clinical appeals nurse and non- clinical supporting team members within ... evaluate clinical quality and procedures within the Clinical Appeals & Grievance Department Government Programs...addition to the required work experience. **Licenses/Certifications:** + Health Services\ RN - Registered Nurse -… more
    CareFirst (11/15/24)
    - Save Job - Related Jobs - Block Source
  • Registered Nurse RN

    Trinity Health (Springfield, MA)
    …program. BSN graduate preferred, Master's preferred + **Licensure** : Current Licensure as a Registered Nurse RN in Massachusetts. + **Certification** : BLS ... level of care determinations using screening criteria, and assists the physician, bedside Registered Nurse , ICC and Social Worker with utilization management and… more
    Trinity Health (11/16/24)
    - Save Job - Related Jobs - Block Source
  • Case Manager (CM) - Registered Nurse

    Select Medical (Los Angeles, CA)
    …Century City / Los Angeles, CA Case Manager (CM) - Full Time (on-site) Registered Nurse ( RN ) or Licensed Clinical Social Worker (LCSW) **Pay Rate: $50 - ... to the patient. **Qualifications** **Minimum Qualifications** + Current licensure in a clinical discipline per state guidelines ( RN , LCSW preferred). + Previous… more
    Select Medical (11/22/24)
    - Save Job - Related Jobs - Block Source
  • RN / Registered Nurse - Care…

    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... - Care Coordinator (Community) Exemption Status Exempt Department Clinical Services Manager Title Care Team Supervisor Direct Reports… more
    CareOregon (09/27/24)
    - Save Job - Related Jobs - Block Source
  • 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 ... Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC...agencies. Good working knowledge of regulatory requirements/standards. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
    LA Care Health Plan (11/20/24)
    - Save Job - Related Jobs - Block Source
  • Clinical Appeals Supervisor…

    CareFirst (Baltimore, MD)
    **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor ( RN ) directs and coordinates the accurate implementation of the clinical appeal ... and serves as a resource for associates within the Clinical Appeals and Analysis unit supporting Government...**Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse -… more
    CareFirst (11/09/24)
    - Save Job - Related Jobs - Block Source
  • CDOC Registered Nurse ( Nurse

    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/4555045) Apply  CDOC Registered Nurse ( Nurse I) Salary $7,442.00 Monthly Location Statewide,… more
    State of Colorado (09/26/24)
    - Save Job - Related Jobs - Block Source
  • 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 ... Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US,… more
    LA Care Health Plan (09/20/24)
    - Save Job - Related Jobs - Block Source
  • Registered Nurse ( RN )…

    University of Virginia (Charlottesville, VA)
    …2 years acute care hospital experience. Licensure: Licensed to Practice as a Registered Nurse in the Commonwealth of Virginia required. PREFERRED QUALIFICATIONS: ... Under general direction: The Utilization Management RN serves as a leader resource in the...complex medical documentation: + Demonstrates competence in interpretation of clinical data, and the application of UM tools. +… more
    University of Virginia (11/12/24)
    - Save Job - Related Jobs - Block Source
  • Clinical Appeals Manager - RN

    CareFirst (Baltimore, MD)
    …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... for our membership, and support NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department. We are looking for an experienced… more
    CareFirst (11/09/24)
    - Save Job - Related Jobs - Block Source
  • CDOC Registered Nurse - Part-time

    State of Colorado (Denver, CO)
    CDOC Registered Nurse - Part-time - Denver 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/4737141) Apply  CDOC Registered Nurse - Part-time - Denver Salary...Colorado? If so, what state issued your license? 07 Nurse Licensure Compact: If appointed to an RN more
    State of Colorado (11/23/24)
    - Save Job - Related Jobs - Block Source
  • 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...+ Use and care of medical equipment used in clinical and infirmary settings + Basic medical indications of… more
    Sacramento County (10/22/24)
    - Save Job - Related Jobs - Block Source
  • Nurse Appeals ( RN )

    Elevance Health (Los Angeles, CA)
    ** Nurse Appeals - Licensed RN .../grievances/quality of care issues and is a resource for clinical and non clinical team members in expediting ... 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 (11/20/24)
    - Save Job - Related Jobs - Block Source
  • 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 (11/07/24)
    - Save Job - Related Jobs - Block Source
  • Registered Nurse I-$25,000 Sign…

    State of Colorado (Denver, CO)
    Registered Nurse I-$25,000 SIGN ON BONUS Colorado Mental Health Hospital in Fort Logan-Denver Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4716699) Apply  Registered Nurse I-$25,000 SIGN ON BONUS Colorado Mental Health Hospital in Fort… more
    State of Colorado (11/05/24)
    - Save Job - Related Jobs - Block Source
  • Registered Nurse I

    State of Colorado (Pueblo, CO)
    Registered NURSE I Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4734422) Apply  Registered NURSE I Salary $42.93 - $50.11 Hourly ... Rights Minimum Qualifications: Education/Licensure/Certification/Experience: Current, valid licensure as a Registered Nurse from the Colorado Board of Nursing… more
    State of Colorado (11/20/24)
    - Save Job - Related Jobs - Block Source
  • RN Auditor Clinical Appeals

    HonorHealth (Scottsdale, AZ)
    …institution Required Experience 2 years RN experience Required Licenses and Certifications Nursing\ RN - Registered Nurse - State Licensure And/Or Compact ... urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization,… more
    HonorHealth (11/20/24)
    - Save Job - Related Jobs - Block Source