- Elevance Health (Los Angeles, 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
- CareFirst (Baltimore, MD)
- …complications. **QUALIFICATIONS:** **Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding… more
- R1 RCM (Boise, ID)
- …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 + **Active AHIMA or… 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
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II...under the direct supervision and management of the A&G Nurse Specialist, RN and/or Medical Director. This… more
- 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 ... Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category:...agencies. Good working knowledge of regulatory requirements/standards. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- Scripps Health (San Diego, CA)
- …Scripps Health for over 10 years. We invite you to join our Revenue Cycle team as a Registered Nurse of Appeals . * In this role, you will be responsible for ... California. **Job:** ** RN * **Organization:** **Scripps Health Corp* **Title:** * RN - Appeals - Revenue Cycle - 4S Ranch/Hybrid* **Location:** *Central San… more
- Dayton Children's Hospital (Dayton, OH)
- …Coaching Skills preferred Education Requirements: Bachelors: Nursing (Required) Certification/License Requirements: [Lic] RN : Registered Nurse ( RN ) - ... Completion of accredited BSN program required Certifications + Licensed Registered Nurse in Ohio required + Current professional certification in evidence-based… more
- 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
- CareFirst (Baltimore, MD)
- …is required in addition to the required work experience. **Licenses/Certifications:** + Health Services\ RN - Registered Nurse - State Licensure and/or ... & Qualifications** **PURPOSE:** The role of the Quality Review Nurse ( RN ) is to evaluate clinical quality...Appeals and Grievances documentation written by the clinical appeals nurse and non-clinical supporting team members… 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...For Service program benefits). + Report member complaints to Appeals and Grievance team for investigation and follow-up, per… more
- University of Washington (Seattle, WA)
- …**UW Medical Center-Montlake - Endocrine Care Center** has an outstanding opportunity for a ** Registered Nurse ** . **WORK SCHEDULE** + 40 hours per week + 5x8 ... staff. This position will be the only full time RN on the team. **PRIMARY JOB RESPONSIBILITIES** + Provides...+ BLS + Active licensure to practice as a Registered Nurse in Washington State **ABOUT UW… 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
- Ascension Health (Destin, FL)
- …rules and regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Florida Board of Nursing ... obtained prior to hire dateor job transfer date required. Licensed as a Registered Nurse in Florida required. Credentialed from State Board ofNursing or current… 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
- 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...appealed utilizing medical, contract and payor rules. + Conducts appeals with external entities and Consultants. + Manages appealed… 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
- 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 ... at 5:00 pm on: 6/3/24, 8/5/24, 10/7/24, 12/2/24 Supervising Registered Nurse - Detention/Correctional Facility is the...Document Required with Application: All applicants MUST record their RN license type, number, and expiration date in the… 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