- Monster (Orange, CA)
- Job Title: Temporary - Grievance & Appeals Nurse Specialist Department: Grievance & Appeals Work Arrangement: Onsite (Full Office) Schedule: Monday - Friday ... About the Role: Client is seeking a Grievance & Appeals Nurse Specialist (Temporary) to join our...with regulatory standards and organizational policies. You will investigate appeals , prepare clinical case narratives, and represent… more
- University Health (San Antonio, TX)
- …The Nurse Auditor, using a unique combination of clinical expertise and regulatory compliance knowledge, monitors and improves the quality ... of clinical documentation and regulatory standards adherence related to the...regulatory requirements for the Appeals and Grievances (MDCP/ Appeals ) processes. The Nurse Auditor is a… 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...monotony. EDUCATION: Graduate of an accredited professional nursing program.Registered nurse with current license to practice in the state… 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 appropriate and correct clinical decisions… more
- Centene Corporation (Columbia, SC)
- …analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters ... for member and provider clinical appeals and ensure letters are compliant with State and NCQA standards. + Maintain files and logs for all appeals +… 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 ... (A&G) & General Operations ( Clinical ) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals & Grievances… more
- CVS Health (Hartford, CT)
- …time zone) with occasional weekends and holidays on a rotation schedule. The Appeals Nurse Consultant position is responsible for processing the medical ... a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,...in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates… more
- CVS Health (Hartford, CT)
- …we do it all with heart, each and every day. **Position Summary** The Appeals Nurse Consultant position is responsible for processing the medical necessity of ... a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,...in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates… more
- CVS Health (Hartford, CT)
- …business hours 8a-5p in time zone of residence Monday - Friday. The Appeals Nurse Consultant position is responsible for processing the medical necessity ... of Medicare appeals for participating providers. Primary duties may include, but...duties may include, but are not limited to: Requesting clinical , research, extrapolating pertinent clinical , applying appropriate… more
- CVS Health (Columbus, OH)
- …support cost-effective quality care for members. Administers review and resolution of clinical complaints and appeals . Interprets data obtained from clinical ... regulatory and accreditation requirements for members and providers. Coordinates clinical resolutions with internal and external support areas. **Required… more
- Charter Care Health Partners (Providence, RI)
- Summary: The Clinical Appeals - Author performs appeals and denials management and represents the hospital where claims were denied by either governmental ... contractors or commercial payers. Completes comprehensive reviews of clinical documentation to determine if an appeal is warranted. Writes compelling clinically… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all ... need the following: Required Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive… more
- Henry Ford Health System (Troy, MI)
- …GENERAL SUMMARY: Unit Description: Health Alliance Plan (HAP) is looking to grow our Medical Appeals Team with an experienced Registered Nurse ! We are a team of ... RN PROVIDER APPEALS COORDINATOR - MEDICAL APPEALS -...+ Minimum of two (2) years of experience in clinical management of patients in an inpatient or ambulatory… more
- City and County of San Francisco (San Francisco, CA)
- …assists with designing and implementing plans for meeting such needs. The Clinical Nurse Specialist performs other related duties as assigned/required. Minimum ... by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- State of Colorado (Denver, CO)
- …assigning responsibilities + During specific shifts, functions in the role of Charge Nurse and provides clinical and administrative supervision of nursing staff ... of work, providing clinical leadership and teaching clinical interventions + Functions as the Charge Nurse...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)
- Charge Nurse RN II (Internal Pool)- CO Mental Health Hospital in Fort Logan (S. Denver) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5076532) ... Apply Charge Nurse RN II (Internal Pool)- CO Mental Health Hospital...coordinates and implements medical and psychiatric crisis intervention in clinical emergencies assuring compliance with nursing standards and policies/procedures.… more
- State of Colorado (Pueblo, CO)
- Registered Nurse III- House Supervisor -CMHHIP Nursing Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5074407) Apply Registered Nurse ... state of residence to another state within the Enhanced Nurse Licensure Compact (eNLC), you must apply for a...This position is responsible for assisting nursing staff with clinical direction/supervision of nursing staff, QA/PI activities and to… 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 (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
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