- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound clinical judgement to ... timeframes.The TeamAs an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a liaison and business expert for member and… more
- R1 RCM (Boise, ID)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Nurse ** , you will help our hospital clients by ... production-driven position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical records and… more
- Molina Healthcare (Midvale, UT)
- …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously ... _For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...internet connectivity of high speed required._ **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical… more
- CVS Health (Hartford, CT)
- …work. **Position Summary** Responsible for the review and resolution of clinical appeals . Reviews documentation and interprets data obtained from clinical records to ... position may support UM (includes expedited), MPO, Coding, or Behavioral Health appeals . **Required Qualifications** + Must have active and unrestricted RN licensure… more
- TEKsystems (Reston, VA)
- …as needed. Reviews researches problematic correspondence and works on special projects with Appeals Nurse or Management. 25 Interacts regularly with and responds ... Description PURPOSE: The Appeals Specialist II will be responsible for the...will be responsible for the initial intake analysis of appeals /grievances correspondence and determination of next steps with minimal… more
- Mount Sinai Health System (New York, NY)
- …for appeals , On / Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in ... department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status of… more
- Guidehouse (New York, NY)
- **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** + Performs chart review ... of identified patients to identify quality, timeliness and appropriateness of patient care + Conducts admission reviews for Medicare, Medicaid beneficiaries, as well as private insurers and self-pay patients, based on appropriate guidelines + Uses these… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and ... collecting, organizing and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety of sources. We are looking… 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...electronic database system. The Appeal Manager should be a nurse who has 3-5 years or more of experience… more
- R1 RCM (Boise, ID)
- …analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Supervisor** , you will help support clinicians who conduct a ... comprehensive review of clinical denials and formulate appeals based on clinical documentation, evidence-based medical necessity criteria, physician documentation,… 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
- CenterWell (Honolulu, HI)
- …to, managing and monitoring all payer requests for additional documentation (ADR), appeals and denials. Works with branch staff to gather required information and ... collaborates with branch and billing staff to determine appropriate response, manages appeals process. + Monitors and responds to all requests related to revenue… more
- State of Colorado (Denver, CO)
- Charge Nurse RN II - CO Mental Health Hospital in Fort Logan (S. Denver) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5021723) Apply Charge ... Nurse RN II - CO Mental Health Hospital in...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Denver, CO)
- CDOC Mid Level Provider / Nurse Manager - (DENVER) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5019611) Apply CDOC Mid Level Provider / ... Nurse Manager - (DENVER) Salary $8,788.00 - $12,302.00 Monthly...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Denver, CO)
- Assistant Nurse Manager - Nurse III -...of the department's action. For more information about the appeals process, the official appeal form, and how to ... Fort Logan (S. Denver) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5012615) Apply Assistant Nurse Manager - Nurse III - Colorado… more
- State of Colorado (Pueblo, CO)
- Registered Nurse I - Nursing Residency Program - CMHHIP - Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5007135) Apply Registered ... Nurse I - Nursing Residency Program - CMHHIP -...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Sterling, CO)
- CDOC Registered Nurse - Part-time - Sterling Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4992041) Apply CDOC Registered Nurse - ... Sterling, CO Job Type Part Time Job Number CAA Nurse I SCF 07/2025 Department Department of Corrections Division...of the department's action. For more information about the appeals process, the official appeal form, and how to… 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) ... Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 06/2025 Department Department of Corrections Division...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- US Tech Solutions (Columbia, SC)
- …NICE TO HAVE skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills Behavioral Health or infusion therapy ... line of business. Previous Medicare experience and /or UR experience/Process Appeals requests/can have experience in either Utilization management or Appeals… more
- State of Colorado (Limon, CO)
- LICENSED PRACTICAL NURSE - (LIMON) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4968134) Apply LICENSED PRACTICAL NURSE - (LIMON) ... performs instruction and orientation; + Assists physicians, physician assistants, and nurse practitioners with minor medical and surgical procedures; + Ensures… more
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