- Molina Healthcare (Kearney, NE)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests ... reviews of previously denied cases in which a formal appeals request has been made or upon request by...equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- HCA Healthcare (Nashville, TN)
- …UT, VA). Do you want to join an organization that invests in you as a Clinical Appeals Nurse RN? At Parallon, you come first. HCA Healthcare has committed up to ... have the opportunity to make a difference. We are looking for a dedicated Clinical Appeals Nurse RN like you to be a part of our team. **Job Summary and… more
- BayCare Health System (Clearwater, FL)
- …be working remotely?** Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Clinical Appeals Nurse - Health Plan **Location** Clearwater:Park Place | ... 2 years of experience with case management and/or clinical appeals or claims. + Registered Nurse **Facility:**...and/or clinical appeals or claims. + Registered Nurse **Facility:** BayCare Health System, Admin - Non Hospital… more
- University of Washington (Seattle, WA)
- …Medicine's Patient Financial Services Department** has an outstanding opportunity for a **Clinical Appeals and Disputes Nurse .** **WORK SCHEDULE** + 100% FTE + ... 100% Remote + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ensures that payers are prepared to reimburse the UW Medicine for services in… more
- Elevance Health (FL)
- ** Nurse Appeals - Litigation & Legal Support** **In Office Expectation:** This role is **Virtual** ; This role enables associates to work virtually full-time, ... will be necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support** is responsible for investigating and processing… more
- Evolent (Springfield, IL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... the safety net required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily… more
- Dignity Health (Rancho Cordova, CA)
- …and maintaining patient confidentiality (HIPAA) are also essential. Ultimately, the Appeals and Grievances Nurse monitors denial trends, recommends corrective ... **Job Summary and Responsibilities** The Appeals and Grievances LVN is a critical role...relevant documentation is presented to the Medical Director. The nurse must meticulously track and document all appeal activities,… more
- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and electronic ... format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible to develop a… more
- BJC HealthCare (St. Louis, MO)
- …experience) **Additional Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist with infusion appeals for both government ... be handling clinical denials and sending them to a nurse to review and appeal and then they will...clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be able to multi-task and maintain… more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with the development of a… more
- BronxCare Health System (Bronx, NY)
- …the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to ... identification of patterns and trends identified during the course of appeals preparation. Conduct departmental performance improvement audits, analyze findings and… more
- McLaren Health Care (Mount Pleasant, MI)
- …. Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews ... of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and achieve optimal payment for… more
- St. Luke's University Health Network (Allentown, PA)
- …a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... formal meetings with auditor or payor representatives in defense of coding appeals , as needed. + Maintain necessary audit/appeal activity documents including Excel… 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 ... notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the...* Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum of… more
- UNC Health Care (Kinston, NC)
- …the Physician Advisors and subject matter experts for all audit and appeals work activities. Assists with documentation review to support the clinical documentation ... specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying established criteria to evaluate the… more
- Integra Partners (Troy, MI)
- …care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key role in collaborating ... 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
- Cognizant (Salem, OR)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... + Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- State of Colorado (Denver, CO)
- Nurse Supervisor - Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5180324) Apply Nurse Supervisor - Denver Salary $8,369.00 - ... Location Denver, CO Job Type Full Time Job Number Nurse III 34377 Den 12/2025 Department Department of Corrections...Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel… more
- State of Colorado (Denver, CO)
- Registered Nurse I-Colorado Mental Health Hospital in Fort Logan-Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5166359) Apply ... Registered Nurse I-Colorado Mental Health Hospital in Fort Logan-Denver Salary...of the department's action. For more information about the appeals process, the official appeal form, and how to… more