- Cognizant (Phoenix, AZ)
- …need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and… 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
- 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 ... and post-service concerns, reviewing medical records and documentation to evaluate appeals , conducting timely and accurate first-level clinical reviews using… more
- McLaren Health Care (Grand Blanc, MI)
- …and commercial insurance. 8. Educates health team colleagues about complex clinical appeals , utilization review, including role, responsibilities tools, and ... duties as required and directed. **Qualifications:** _Required_ + State licensure as a registered nurse (RN) + Bachelor's degree in nursing from accredited… more
- Centene Corporation (New York, NY)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... **Hours: 8:30am-5pm EST Monday - Friday.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals...Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact… more
- CVS Health (OH)
- … resolutions with internal and external support areas. **Required Qualifications** + A Registered Nurse that must hold an unrestricted license in their state ... quality care for members. Administers review and resolution of clinical complaints and appeals . Interprets data obtained from clinical records to… more
- Catholic Health (Buffalo, NY)
- …finance, business management, operational analysis, information systems or related field + Registered Nurse with a four (4) year degree and Unrestricted ... based on role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for the people, carrying out… more
- McLaren Health Care (Mount Clemens, MI)
- …outcomes and fulfills the obligation and responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer ... other related duties as required and directed. **Qualifications:** **_Required:_** + Registered Health Information Technician (RHIT), Licensed Practical Nurse … 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...During specific shifts, functions in the role of Charge Nurse and provides clinical and administrative supervision… 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 06/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 06/05/2025 Closing Date...Applicant must possess a current, valid license as a Registered Nurse from the Colorado Board of… more
- State of Colorado (Pueblo, CO)
- Nurse I CMHHIP Relief Pool - Registered Nurse I - CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5102074) Apply Nurse I ... CMHHIP Relief Pool - Registered Nurse I - CMHHIP Salary $43.80 - $61.31 Hourly...This position is responsible for assisting nursing staff with clinical direction of nursing staff, QA/PI activities and to… 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 ... closing date and time listed. + Description + Benefits + Questions Department Information Registered Nurse II-Full Time CMHHIP This posting will be used to fill… more
- Sacramento County (Sacramento, CA)
- Registered Nurse D/CF (Level I/II) Print...+ Use and care of medical equipment used in clinical and infirmary settings + Basic medical indications of ... (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/454059) Apply Registered Nurse D/CF (Level I/II) Salary $62.99 - $80.17 Hourly Location… more
- Veterans Affairs, Veterans Health Administration (Eagan, MN)
- Summary The Home and Community Based Services program Registered Nurse is a member of the interdisciplinary team responsible for providing centralized, ... at the right time. Responsibilities **These positions may be filled by a Registered Nurse , Physical Therapist, or Occupational Therapist. These positions are… 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, Youth Services Center -… more
- Fallon Health (Worcester, MA)
- …Degree in nursing, or equivalent. **License:** Active and unrestricted licensure as a Registered Nurse in Massachusetts. **Experience:** Three to five years of ... of clinical criteria and medical necessity determinations. The Appeal Nurse is responsible for ensuring compliance with all applicable state and federal… more
- Commonwealth Care Alliance (Boston, MA)
- …in primary care or care management, including: + 5+ years' experience as Registered Nurse in a high touch clinical environment or home care + AND + 2+ ... management and care delivery. Within the CIC Program, the Registered Nurse (RN) serves as an integral...and social needs. The RN uses evidenced-based care approaches, clinical skills, education, and training to influence the … more
- Beth Israel Lahey Health (Cambridge, MA)
- …high reliability processes to reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, ... skills to prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for medical peer review.… more
- Walgreens (Deerfield, IL)
- …customers, patients, team members and communities. **Job ID:** 1655228BR **Title:** Registered Nurse (RN) Specialty **Company Indicator:** Walgreens **Employment ... Basic Qualifications:** + Associate's degree in Nursing + Current license/registration as an RN ( Registered Nurse ) with the State Board of Nursing in the state… more
- CommonSpirit Health Mountain Region (Westminster, CO)
- …cultivate excellence and achieve professional fulfillment united in humankindness. As a Registered Nurse (RN) you will assume responsibility and accountability ... care for orthopedic, abdominal, and general surgeries. 5 West appeals to anyone interested in broadening their skillset as...about your success. We offer Certification pay and a Clinical Career Ladder to help you grow and recognize… more