- 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...specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service… 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 ... Clinical ) is responsible for the daily oversight of clinical appeals and grievances functions within the...for accuracy, clarity, and cultural appropriateness and sensitivity. + Review and monitor procedures for identifying quality of care… 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 ... independently as well as in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates 7 days per week, 365… more
- CVS Health (Tallahassee, FL)
- …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 ... independently as well as in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates 7 days per week, 365… more
- US Tech Solutions (Columbia, SC)
- …services, and appeals . Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and ... + 80% May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …a Registered Nurse . 3 years with progressive experience in utilization review , preferred. Prior experience writing clinical denial appeal letters required. ... 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… more
- Henry Ford Health System (Troy, MI)
- …Nurse ! We are a team of Registered Nurses (3 and counting) and Utilization Review Coordinators (4) that review appeals for medical necessity using ... RN PROVIDER APPEALS COORDINATOR - MEDICAL APPEALS -...+ Responsible for investigating Provider Appeal requests and Code Review inquiries for all Utilization Management divisions, including delegated… more
- Fallon Health (Worcester, MA)
- …related work experience including state/federal regulatory agency and three to five years clinical experience in utilization review , appeals , or case ... of clinical criteria and medical necessity determinations. The Appeal Nurse is responsible for ensuring compliance with all applicable state and federal… more
- Molina Healthcare (Warren, MI)
- …set schedule) Looking for a RN with experience with appeals , claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, ... identified by the Payment Integrity analytical team; requires decision making pertinent to clinical experience + Documents clinical review summaries, bill… more
- Beth Israel Lahey Health (Boston, MA)
- …a Registered Nurse (RN), Massachusetts + Three years of recent clinical or utilization management experience _Preferred:_ + Bachelor's degree in nursing or ... Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on… more
- University of Utah Health (Salt Lake City, UT)
- …stay review . + Communication to third-party payers for initial and concurrent clinical review . + Reviews patient chart to ensure patient continues to meet ... expected LOS, expected cost, or over/under-utilization of resources. + Performs verbal/fax clinical review with payer as determined by nursing judgment and/or… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …review , special review requests, and UM pre\-certifications and appeals , utilizing medical appropriateness criteria, clinical judgement, and contractual ... 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
- Beth Israel Lahey Health (Plymouth, MA)
- …data to establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal ... team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding… 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 ... assuring timely completion of work, providing clinical leadership and teaching clinical interventions + Functions as the Charge Nurse , when assigned, and… more
- State of Colorado (Denver, CO)
- …abilities and competencies necessary to the position through continuing education, clinical supervision, literature review and participating in discipline and ... Charge Nurse RN II (Internal Pool)- CO Mental Health...coordinates and implements medical and psychiatric crisis intervention in clinical emergencies assuring compliance with nursing standards and policies/procedures.… 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
- Beth Israel Lahey Health (Cambridge, MA)
- …reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, interpret data, and implement ... Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported...federal regulators, insurance appeals , internal correspondence, and clinical summaries for medical peer review . 5.… 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
- State of Colorado (Garfield County, CO)
- …knowledge, and competencies necessary to the position through continuing education, clinical supervisory literature review , and participating in discipline and ... NURSE I - Veterans Community Living Center at...requirements. + Performs both admission and daily assessments during clinical stay, identifying critical stay, identifying critical incidents, emergencies,… 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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