- University of Washington (Seattle, WA)
- …least one of the following: certified healthcare chart auditor, certified professional in utilization review (or utilization management or healthcare ... Medicine's Patient Financial Services Department** has an outstanding opportunity for a **Clinical Appeals and Disputes Nurse .** **WORK SCHEDULE** + 100% FTE +… more
- Elevance Health (Columbus, OH)
- ** Nurse Appeals RN** **Location** : Ohio-Cincinnati,...AS or BS in Nursing. + Utilization Management , medical management , or appeals ... employment, unless an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- CVS Health (Hartford, CT)
- …licensure in state of residence **Preferred Qualifications** Managed Care experience Utilization Management experience Appeals experience Pre Certification ... business hours 8a-5p in time zone of residence Monday - Friday. The Appeals Nurse Consultant position is responsible for processing the medical necessity… more
- BronxCare Health System (Bronx, NY)
- …assist the department's leadership develop strategies for denial prevention, improved utilization management , documentation of medical necessity and identify ... avoidable day and barriers to discharge processes pertaining to utilization management . - Liaisons and coordinates with...On the job or formal training in certified case management , denial and appeals management … more
- Henry Ford Health System (Troy, MI)
- …for investigating Provider Appeal requests and Code Review inquiries for all Utilization Management divisions, including delegated entities. + Summarize outcome ... Alliance Plan (HAP) is looking to grow our Medical Appeals Team with an experienced Registered Nurse !...or at least three (3) years of experience in Utilization Management or Case Management .… more
- LA Care Health Plan (Los Angeles, CA)
- …least 8 years of clinical appeals and grievances experience in a managed care, utilization management and/or case management setting, At least 2 years in ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department:...position will mentor, coach, and may provide feedback to management on performance of staff. Ensure team effectiveness and… more
- TEKsystems (San Bernardino, CA)
- Clinical Appeals Nurse - Revenue Cycle Management We are looking for a Clinical Appeals Nurse to join our Revenue Cycle Management team. In this ... medical records. + Experience in clinical appeals , utilization review, or revenue cycle management . +...appeals , utilization review, or revenue cycle management . + Excellent attention to detail and organizational skills… more
- McLaren Health Care (Mount Pleasant, MI)
- …education sessions to maintain competency and knowledge of regulations in denials, utilization management , care management , clinical documentation, and ... . Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews… more
- Nuvance Health (Danbury, CT)
- …in Milliman and InterQual Guidelines required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum ... members of the interdisciplinary care team * Current working knowledge of utilization management , performance improvement and managed care reimbursement. Working… more
- Northwell Health (Melville, NY)
- … Review standard and regulations. + Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts ... + Inpatient clinical experience; 4+ years preferred. + Prior Acute Case Management and/or Utilization Review experience, preferred. + Must have experience… more
- Cognizant (Salem, OR)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals… more
- Integra Partners (Troy, MI)
- …experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a ... Medical Director to perform benefit and medical necessity reviews and appeals within an NCQA-compliant UM program. Salary: $60,000.00/annual JOB QUALIFICATIONS:… more
- Nuvance Health (Danbury, CT)
- *Description* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within the first 12-24 hours ... If unable to resolve, escalate to the PA and Utilization Review (UR) Leadership. * Coordinate with the care...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 251212-5613FP-001 Location East Hartford, CT Date Opened 12/16/2025 12:00:00 AM ... to learn more about joining our team as a Utilization Review Nurse Coordinator! The State of...types of case reviews for quality and appropriate medical management , cost containment, peer review and rehabilitation; + Implement… more
- McLaren Health Care (Port Huron, MI)
- …as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate ... or order entry for timeliness, appropriateness and completeness as pertains to the utilization management process including level of care, medical necessity, and… more
- UNC Health Care (Kinston, NC)
- …applied clinical experience as a Registered Nurse required. + 2 years utilization review, care management , or compliance experience preferred. + Minimum 1 ... support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- **12/2/2025 - REVISED FTE *_SUMMARY:_* We are currently seeking a*Staff Nurse *to join our Utilization Management department for the/Emergency Department / ... *Assessment:* * Collects, reviews, and documents clinical data relevant to utilization management , including patient status, treatment plans, and healthcare… more
- Saint Francis Health System (OK)
- …their placement in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers ... benefits of patients to validate accurate level of care utilization . Investigates and prepares appeals for insurance...nor does it prohibit the assignment of additional duties. Utilization Review Management - Yale Campus Location:… more
- Sanford Health (Rapid City, SD)
- …providing direct supervision of all departmental staff. Maintains a standardization of utilization management process to ensure all policies and procedures are ... Full time **Weekly Hours:** 40.00 **Department Details** Join our team as a Utilization Review and Case Management Manager and lead a high-impact, data-driven… more
- Huron Consulting Group (Chicago, IL)
- …the expert you are now and create your future. The Manager of Utilization Management is responsible for planning, organizing, developing, and directing ... Review Plan and the overall operation of the Utilization Management Department in accordance with federal,...Performance Tracking and Improvement: Provides analysis and reports of utilization , denials, and appeals KPIs, trends, patterns,… more
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