- University Health (San Antonio, TX)
- …Program (MDCP) and regulatory requirements for the Appeals and Grievances (MDCP/ Appeals ) processes. The Nurse Auditor is a subject matter expert for ... POSITION SUMMARY/RESPONSIBILITIES The Nurse Auditor, using a unique combination of clinical... Auditor is a subject matter expert for the Appeals and Grievances processes ensuring all required processes and… more
- Monster (Allentown, PA)
- …as necessary to ensure that documentation is entered and transmitted to insurance carriers within acceptable timeframes to comply with appeal deadlines. Provides ... as deemed clinically appropriate. Investigates managed care and commercial insurance rejections, denials for possible experimental services and coding issues,… more
- Genmab (Berkeley Heights, NJ)
- …has experience in case management, phone-based support work and the health insurance landscape. Patient Service Specialists are critical in the success and quality ... and the healthcare provider (including their office staff) to navigate through insurance coverage and access of the medicationNavigate patients and offices through… more
- Mount Sinai Health System (New York, NY)
- …appeals , On / Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in ... work as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials +… 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 Location: Los ... the safety net required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily… more
- Molina Healthcare (Omaha, NE)
- …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...Chief Medical Officer for Administrative Law Judge pre-hearings, State Insurance Commission, and Meet and Confers. + Represents Molina… more
- Centene Corporation (Columbia, SC)
- …workplace flexibility. **Position Purpose:** Act as the liaison for all statewide appeals , fair hearings, review organizations, and other external type appeals . ... both State and NCQA requirements. + Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services… 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 -...Word. Excel and Access preferred. CERTIFICATIONS/LICENSURES REQUIRED: + Registered Nurse (RN) with current Michigan licensure. PREFERRED EXPERIENCE: +… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all care sites with ... external third-party payers to appeal denied claims and retrospectively identifies appeals determination as indicated through research and coordination of completion… 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 Fort Logan-Denver Salary...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...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) ... Monthly Location Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 06/2025 Department Department of Corrections Division Clinical and Correctional… 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 - ... + Description + Benefits + Questions Department Information Registered Nurse II-Full Time CMHHIP This posting will be used...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Pueblo, CO)
- Nurse I - Registered Nurse I -...of the department's action. For more information about the appeals process, the official appeal form, and how to deliver ... (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 (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...Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel… 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 - ... Location Sterling, CO Job Type Full Time Job Number Nurse III 30492 09/2025 Department Department of Corrections Division...Short and long term disability coverage; + Paid life insurance ; + 11 paid holidays per year plus vacation… 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 Fitzsimons -… 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 ... Plan plus 401K and 457 plans; + Medical and Dentalhealth plans; + Paid life insurance ; + Short and long-term disability coverage; + 11 paid holidays per year plus… more
- State of Colorado (Garfield County, CO)
- NURSE I - Veterans Community Living Center at...of the department's action. For more information about the appeals process, the official appeal form, and how to ... Rifle Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4907915) Apply NURSE I - Veterans Community Living Center at Rifle Salary $42.94 Hourly… more
- State of Colorado (Golden, CO)
- Registered Nurse I, RN I - Campus at Lookout Mountain, Youth Services Center - Golden Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5008113) ... Apply Registered Nurse I, RN I - Campus at Lookout Mountain,...patient information (oral and written) according to federal Health Insurance Portability and Accountability Act (HIPAA) regulations. Initiates consultations/referrals… more
