- Christus Health (Houston, TX)
- …appealing all inappropriate denials through all possible levels of the appeal process. The RN Clinical Appeals Nurse will actively manage, maintain and ... point of contact for clinical denials and appeal inquiries. The Clinical Appeals Nurse will review each case identified/referred for appeal based on Milliman… more
- Monster (Allentown, PA)
- …Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending. Coordinates RAC ... appeals for complex case reviews for medical necessity, including...of an accredited, professional nursing program. Must have current RN license to practice in the state of Pennsylvania… more
- HireMaster (Lincoln, NE)
- …12. Ability to maintain regular and punctual attendance. EDUCATION AND EXPERIENCE: Current Registered Nurse licensure from the State of Nebraska or approved ... appropriate algorithm. 6. *Participates in concurrent and retrospective denials and appeals process by researching issues surrounding the denial, participating in… more
- University Health (San Antonio, TX)
- …HMO, and private insurance coverage is highly preferred. LICENSURE Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners ... and regulatory requirements for the Appeals and Grievances (MDCP/ Appeals ) processes. The Nurse Auditor is a subject matter expert for process adherence… 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 ... presentations. Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and… more
- State of Colorado (Denver, CO)
- …(HP III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5058918) Apply Registered Nurse Complaints Health Compliance Inspector - ... Registered Nurse Complaints Health Compliance Inspector -...FAA00731 (HP III RN ) Salary $80,916.00 - $90,648.00 Annually Location Denver, CO Job… more
- State of Colorado (Golden, CO)
- Registered Nurse I, RN I...of the department's action. For more information about the appeals process, the official appeal form, and how to deliver ... Mountain, Youth Services Center - Golden Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5008113) Apply Registered Nurse I, RN I -… more
- State of Colorado (Denver, CO)
- …III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5075443) Apply Registered Nurse Health Compliance Inspector, Nursing ... Registered Nurse Health Compliance Inspector, Nursing...Facilities - FAA00867 (HP III RN ) Salary $80,916.00 Annually Location Denver, CO Job Type… more
- St. Luke's University Health Network (Allentown, PA)
- …near vision, visual monotony. EDUCATION: Graduate of an accredited professional nursing program. Registered nurse with current license to practice in the state ... + Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending. + Coordinates RAC … more
- Beth Israel Lahey Health (Boston, MA)
- …other related duties as required and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse ( RN ), Massachusetts + Three years of recent ... Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on the… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive experience in utilization review, ... help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all care… 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/4963973) Apply CDOC Registered Nurse ( Nurse I) Salary $7,591.00 - $10,627.00 Monthly… 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 ... are at 5:00 pm on: 2/3/25, 4/7/25, 6/2/25, 8/4/25, 10/6/25, 12/1/25 Supervising Registered Nurse - Detention/Correctional Facility is the first level supervisory… more
- Molina Healthcare (Omaha, NE)
- … appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of ... these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. **Preferred… more
- State of Colorado (Pueblo, CO)
- Nurse I - Registered Nurse ...of the department's action. For more information about the appeals process, the official appeal form, and how to deliver ... - CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5039283) Apply Nurse I - Registered Nurse I - CMHHIP Salary $43.80 - $61.31… more
- State of Colorado (Pueblo, CO)
- …office? 10 A requirement of the position is that you possess and maintain a VALID Registered Nurse ( RN ) License issued by the State of Colorado or any ... Registered Nurse III- House Supervisor -CMHHIP...+ Completes random Nextel phone audit to ensure charge RN is carrying the unit Nextel + Calls and… more
- Commonwealth Care Alliance (Springfield, MA)
- …complexities that require intensive care management and care delivery. Within the CIC Program, the Registered Nurse ( RN ) serves as an integral member of an ... and based on the fluctuating needs of the defined panel of members, the Registered Nurse will engage in regular assessments, visits at regularly scheduled… 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 ... listed. + Description + Benefits + Questions Department Information Registered Nurse II-Full Time CMHHIP This posting...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)
- Registered Nurse I-Colorado Mental Health Hospital in Fort Logan-Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5078182) Apply ... Registered Nurse I-Colorado Mental Health Hospital in...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
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