- R1 RCM (Chicago, IL)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals and Denials Manager ** , you will ... management. **Here's what you will experience working as a Clinical Appeals & Denials Manager :**...trends, challenges, and process improvement opportunities. **Required Skills:** + Registered Nurse (active or inactive in good… more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... support NCQA accreditation and the Divisional Goals for the Clinical Appeals and Grievance department. We are...Licensure Upon Hire Required + CCM - Certified Case Manager Upon Hire Preferred **Experience:** 5 years' Experience in… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor ( RN ) directs and coordinates the accurate implementation of the clinical appeal ... training presentations for internal and external stakeholders. Supports the Manager of Clinical Appeals and...**Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse -… 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 ... to home rate. **Benefits of working as a Case Manager with us:** + Excellent Orientation Program + Paid...patient. **Qualifications** **Minimum Qualifications** + Current licensure in a clinical discipline per state guidelines ( RN , LCSW… more
- 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: ...Care's culturally diverse membership. The position supports the A&G Clinical Manager . This role also assists the… more
- 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… more
- Elevance Health (Walnut Creek, CA)
- ** Manager II Grievance/ Appeals ( RN )-California** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will live ... **Costa Mesa** + **Palo Alto** + **Walnut Creek** The ** Manager II Grievance/ Appeals ** is responsible for management...clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non- clinical and… more
- VNS Health (Manhattan, NY)
- …navigating the complexities of healthcare? VNS Health Plans is seeking a dedicated Manager , Grievance and Appeals ( RN )to lead the daily operations ... direct oversight and the day to day management of clinical appeals review processes within Appeals...+ License and current registration to practice as a registered professional nurse in New York State… 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/4555045) Apply CDOC Registered Nurse ( Nurse I) Salary $7,442.00 Monthly Location Statewide,… more
- 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
- 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
- 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
- State of Colorado (Denver, CO)
- Registered Nurse I-$25,000 SIGN ON BONUS...during own shift and proximal shifts. In collaboration with Nurse Manager and treatment team, recommends a ... 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… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES...or health plan. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California,… more
- Mount Sinai Health System (New York, NY)
- …education to Case Managers and other hospital personnel as needed. The Nursing Clinical Manager collaborates with Appeals Management, Managed Care ... **Job Description** The Nursing Clinical Manager (NCM) for Case Management...nurse . Licensing and Certification Requirements (if applicable) License: RN (current) and Certification Issuing Agency: NYS/ Department of… more
- Dayton Children's Hospital (Dayton, OH)
- …Coaching Skills preferred Education Requirements: Bachelors: Nursing (Required) Certification/License Requirements: [Lic] RN : Registered Nurse ( RN ) - ... Education + Completion of accredited BSN program required Certifications + Licensed Registered Nurse in Ohio required + Current professional certification in… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …single largest account Position Summary: The RN Clinical Provider Post Service Review Manager , led by a Registered Nurse , is responsible for a team ... with all levels of the organization Education/Relevant Experience: + Active professional Registered Nurse in MA required. Bachelor's degree preferred +… more
- WesleyLife (Urbandale, IA)
- …Access your wages before payday for unexpected expenses. **Our ideal candidate** will be a registered nurse in Iowa with at least one year of home health ... Nurse Case Managers, who will work with our Clinical Managers on providing respectful feedback that holds team...Insurance + Driver's License + Basic Life Support + Registered Nurse **Experience** **Required** + 2 years:… more
- Sharp HealthCare (San Diego, CA)
- … (CCM) - Commission for Case Manager Certification; Bachelor's Degree in Nursing; California Registered Nurse ( RN ) - CA Board of Registered Nursing; ... or equivalent experience in the healthcare setting. + California Registered Nurse ( RN ) - CA...will participate in venues to reduce barriers to discharge.The RN CM I Collaborates with Clinical Resource… more
- Alameda Health System (San Leandro, CA)
- SLH Case Manager RN , Per Diem, Days, 8hours + San Leandro, CA + San Leandro Hospital + SLH Social Services + Services As Needed / Per Diem - Day + Care ... + FTE:0.01 + Posted:October 24, 2024 **Summary** **Job Summary:** The SLH Case Manager RN is responsible for providing comprehensive case management services to… more