- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager , Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & Grievances ... the safety net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G) & General Operations ( Clinical ) is responsible for the… more
- Molina Healthcare (Omaha, NE)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified Professional… more
- State of Colorado (Aurora, CO)
- Nurse Manager /Staffing Development Coordinator-Veterans Community Living Center Fitzsimons - Aurora Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5071672) Apply Nurse Manager /Staffing Development Coordinator-Veterans Community Living Center… more
- Crouse Hospital (Syracuse, NY)
- …health education and outreach programs. Crouse's Care Coordination team is hiring a Manager who is responsible for providing day to day management of the RN ... $95,000 plus based on education and experience Schedule: Full-Time, 8:00am-4:30pm Manager , Care Coordination Responsibilities: + Manager is responsible for… more
- State of Colorado (Denver, CO)
- …and level of staffing during own shift and proximal shifts + Collaboration with Nurse Manager and treatment team, recommends a change in program scheduling to ... During specific shifts, functions in the role of Charge Nurse and provides clinical and administrative supervision...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- WesleyLife (Urbandale, IA)
- …and daily experience of the residents at Wesley at Home. **As a Clinical Manager , you will:** + Support the Nurse Case Managers leading teams of nurses, ... be a part of the revolution! **About the Role: Clinical Manager ** As a Clinical ...responsibility for onboarding and education, delegating tasks to the Nurse Case Managers in coordination with the Clinical… more
- State of Colorado (Pueblo, CO)
- …violations at the lowest level and communicates these to the Staffing Office Nurse Manager within appropriate time frames. + Immediately communicates all ... documentation to identify and address staff deficiencies as directed by the Unit Nurse Manager . + Also, collaborates with non-nursing personnel to address… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …retrospective claim review, special review requests, and UM pre\-certifications and appeals , utilizing medical appropriateness criteria, clinical judgement, and ... for an RN with at least 3 years of clinical experience to join our team\. This position reviews...shifts, 7 AM\-6 PM Eastern Time Zone\. + The nurse does take requests over the phone which requires… more
- State of Colorado (Pueblo, CO)
- Registered Nurse II- CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5039700) Apply Registered Nurse II- CMHHIP Salary $45.99 - ... and time listed. + Description + Benefits + Questions Department Information Registered Nurse II-Full Time CMHHIP This posting will be used to fill multiple… more
- State of Colorado (Pueblo, CO)
- Nurse I - Registered Nurse I...This position is responsible for assisting nursing staff with clinical direction of nursing staff, QA/PI activities and to ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5039283) Apply Nurse I - Registered Nurse I - CMHHIP Salary $43.80 - $61.31 Hourly Location… more
- State of Colorado (Sterling, CO)
- Nurse Supervisor - Sterling Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5072854) Apply Nurse Supervisor - Sterling Salary $8,369.00 - ... $11,717.00 Monthly Location Sterling, CO Job Type Full Time Job Number Nurse III 30492 09/2025 Department Department of Corrections Division Clinical and… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4963973) Apply CDOC Registered Nurse ( Nurse I) ... $10,627.00 Monthly Location Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 06/2025 Department Department of Corrections Division Clinical and… more
- State of Colorado (Denver, CO)
- CDOC Licensed Practical Nurse (LPN) - DENVER Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5081868) Apply CDOC Licensed Practical Nurse ... treatment plans, employs infection control measures, provides referral to appropriate Clinical Services staff for new arrivals, crisis intervention, interviews and… more
- Beth Israel Lahey Health (Cambridge, MA)
- …high reliability processes to reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, ... skills to prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for medical peer review.… more
- Garnet Health (Middletown, NY)
- …Health Medical Center. Responsibilities Under the direction of The Administrator, Coding & Clinical Documentation Improvement and Patient Access, the Manager of ... to make your career home with us as a CLinical Documnetaion Specialist on our CDI team at/in Garnet...day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement… more
- Commonwealth Care Alliance (Springfield, MA)
- …and communities across various locations. This position reports to the CIC APC Clinical Manager . **Supervision Exercised:** No, this position does not have ... as approved + Supports escalation of member grievances and appeals + Supports the procurement of network providers and...care management, including: + 5+ years' experience as Registered Nurse in a high touch clinical environment… more
- State of Colorado (Denver, CO)
- Registered Nurse Complaints Health Compliance Inspector - FAA00731 (HP III RN) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5058918) Apply ... Registered Nurse Complaints Health Compliance Inspector - FAA00731 (HP III...software applications, and communicating through email is required. + Non- clinical or clinical health care experience, preferably… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- Position is On-Site The Behavioral Health Nurse - Managed Care is responsible for coordinating, monitoring, and delivering behavioral health services within a ... community resources. + Authorize services and coordinate referrals based on clinical guidelines and insurance coverage. + Provide telephonic and/or in-person case… more
- Prime Therapeutics (Atlanta, GA)
- …and enters data of these cases in web-based application and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings ... the need for work visa or residency sponsorship **Additional Qualifications** + Registered Nurse (RN). + 5 years of post-degree clinical experience. + Experience… more
- State of Colorado (Denver, CO)
- Registered Nurse Health Compliance Inspector, Nursing Facilities - FAA00867 (HP III RN) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5075443) ... Apply Registered Nurse Health Compliance Inspector, Nursing Facilities - FAA00867 (HP...software applications, and communicating through email is required. + Non- clinical or clinical health care experience, preferably… more