- Genmab (Berkeley Heights, NJ)
- …patients and offices through the complexity of insurance coverage including review of benefit verifications, research of prior authorizations and support through ... the appeals processEvaluate and refer patients to appropriate financial assistance...CenterCollaborate with PSS Field Teams (Field Reimbursement Managers and Nurse Team) to ensure seamless communication and appropriate handoffs… more
- Elevance Health (Chicago, IL)
- ** Appeals Nurse Reviewer I**...Outreach to providers with appeal process instructions. + Clinical review for the RBM and Surgical solution on a ... set of clinical domains, including radiology, cardiology and oncology. The ** Appeals Nurse Reviewer I** is responsible for conducting preauthorization, out… more
- Actalent (Sacramento, CA)
- Job Title: Appeals and Grievances Registered Nurse Job Description We are seeking a skilled professional to join our team and handle member appeals and ... receive appropriate care. This position reports directly to the Nurse Manager and plays a key role in providing...appeals and grievances related to healthcare services. + Review medical records and documentation to evaluate 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 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
- McLaren Health Care (Grand Blanc, MI)
- …commercial appeals beyond the first level, requiring complex clinical review and appeal letter writing. Responsible for collecting, analyzing, and reporting ... commercial insurance. 8. Educates health team colleagues about complex clinical appeals , utilization review , including role, responsibilities tools, and… 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 ... Insurance / State & Federal regulation. + Enters concurrent review information for Review Nurses in Allscripts...Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status… more
- BronxCare Health System (Bronx, NY)
- …the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to ... identification of patterns and trends identified during the course of appeals preparation. Conduct departmental performance improvement audits, analyze findings and… more
- Catholic Health (Buffalo, NY)
- …role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for the people, carrying out and documenting ... the appeals process for denied claims denied due to reasons...and internal stakeholders including, but not limited to, Utilization Review , Case Management, Clinical Documentation Integrity, Health Information Management,… more
- Nuvance Health (Danbury, CT)
- …REQUIRED* * *Hybrid/Remote* * *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within ... behaviors to internal leadership for assistance in resolution. *Responsibilities:* * Review all inpatient admission and observation cases using InterQual, or… more
- Fallon Health (Worcester, MA)
- …appeal to the Plan Medical Director, Center for Medicare/Medicaid Services, contracted reviewer , and the Plan contracted external review agency in accordance ... expectations. Under the direction of the Director, the Appeal Nurse represents, manages and oversees second level appeal cases...and three to five years clinical experience in utilization review , appeals , or case management within a… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 250924-5613FP-001 Location East Hartford, CT Date Opened 9/30/2025 12:00:00 AM Salary ... - is accepting applications for a full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=) (Regulatory) position,… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the ... Minnesota. Some positions may require specialized certifications(s). **Title:** *Staff Nurse - Utilization Review (Float)* **Location:** *MN-Minneapolis-Downtown… more
- Idaho Division of Human Resources (Nampa, ID)
- Utilization Review and Nurse Educator - SHW Posting Begin Date: 2025/09/22 Posting End Date: 2025/10/20 Category: Nursing Work Type: Full Time Location: Nampa, ... Idaho! We are currently seeking a dedicated and experiencedRegistered Nurse Seniorto take on a critical role in our...Seniorto take on a critical role in our Utilization Review , Performance Improvement, Nursing Education programs. This is an… more
- Molina Healthcare (Warren, MI)
- …(Team will work on set schedule) Looking for a RN with experience with appeals , claims review , and medical coding. **Job Summary** Utilizing clinical knowledge ... and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines,… more
- University of Utah Health (Salt Lake City, UT)
- …appropriateness of admissions with associated levels of care and continued stay review . + Communication to third-party payers for initial and concurrent clinical ... review . + Reviews patient chart to ensure patient continues...days, costs/barriers to discharge/transition and denied days. + Prepares appeals on denied cases when appropriate. **Knowledge / Skills… more
- Beth Israel Lahey Health (Boston, MA)
- …Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on ... of care being billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria for… more
- Beth Israel Lahey Health (Plymouth, MA)
- …using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to ... 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 (Pueblo, CO)
- Nurse I - Registered Nurse I - CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5101894) Apply Nurse I - Registered Nurse I ... and time listed. + Description + Benefits + Questions Department Information Registered Nurse I-Full Time CMHHIP This posting will be used to fill multiple… more
- State of Colorado (Pueblo, CO)
- Registered Nurse II- CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5101960) 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
- 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...assessment, written performance assessment or it may include a review of your application material and your responses to… more