- The LaSalle Group (Evanston, IL)
- …4:00 PM (Latest start time: 8:00 AM) Position Summary: We are actively hiring Registered Nurse (RN) Clinical Appeals Specialists to join our client's growing ... Job Title: RN Clinical Appeals Specialist Department: Revenue Cycle...Epic and other relevant systems. Required Qualifications: Active Registered Nurse (RN) license in the state of [Insert State].… more
- Pyramid Consulting, Inc. (Blacklick, OH)
- Immediate need for a talented Appeals nurse (LPN). This is a 06+ months contract opportunity with long-term potential and is located in Ohio(Remote). Please ... and/or managed care setting preferred. Licensed Professional Counselor; Licensed Clinical Social Worker; Licensed Marriage and Family Therapist; Licensed… more
- State of Colorado (Denver, CO)
- …coordinates and implements medical and psychiatric crisis intervention in clinical emergencies assuring compliance with nursing standards and policies/procedures. ... anticipating problems, planning interventions strategies and assigning responsibilities. Provides clinical and administrative supervision of nursing staff on duty.… more
- NavitsPartners (Boston, MA)
- Job Title: Travel - Registered Nurse (RN) - Case Management Location: Hyannis, MA Assignment Type: Travel Contract Duration: 13 Weeks Shift: Monday to Friday | 8:00 ... $2,762 - $2,890 Position Overview: We are seeking an experienced Registered Nurse (RN) specializing in Case Management for a 13-week travel assignment in… more
- State of Colorado (Denver, CO)
- …: Denver, CO Job Type: Full Time Job Number: CAA DEN 34376 NURSE MGR 7.2025 Department: Department of Corrections Opening Date: 07/24/2025 Closing Date: 8/7/2025 ... 24 hours per day for the nursing management and administration of a clinical unit; Provide leadership and vision while supervising, organizing, and reviewing and… more
- Boston Childrens Hospital (Boston, MA)
- …for the appropriate level of care for admissions and with post-discharge appeals of payer denials. They identify and implement initiatives to manage utilization ... resources. Key Responsibilities: Assessing, planning, organizing and overseeing daily clinical operations of care coordination and transitions to address the… more
- Sharp HealthCare (La Mesa, CA)
- …care areas. This position requires the ability to combine clinical /quality considerations with regulatory/financial/utilization review demands to assure patients are ... setting and level of care. The position creates a balance between individual clinical needs with the efficient and cost effective utilization of resources while… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound ... regulatory timeframes.The TeamAs an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a liaison and business expert… more
- Molina Healthcare (Midvale, UT)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... _For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...with internet connectivity of high speed required._ **Job Summary** Clinical Appeals is responsible for making appropriate… more
- R1 RCM (Boise, ID)
- …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help our ... remote, production-driven position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical… more
- Corewell Health (Southfield, MI)
- …when the third-party payors do not meet the expected payment as modeled. The Clinical Appeals Nurse will write comprehensive, factual arguments to present ... RN License Scope of Work: Responsible for completing retrospective clinical appeals for full or partially denied...Required + Background in Case Management. Preferred + Registered Nurse (RN) - State of Michigan Will consider out… more
- Guidehouse (New York, NY)
- **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** + Performs chart ... of care or observation services based on physician certification + Gathers clinical information to conduct continued stay utilization review activities with payers… more
- R1 RCM (Boise, ID)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Supervisor** , you will help support clinicians ... position. **Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor...additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- BronxCare Health System (Bronx, NY)
- …arrive in letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal ... Overview The Appeals Manager is responsible to assist in the...preferred. The Appeal Manager should have experience as a nurse in acute care clinical setting who… more
- State of Colorado (Denver, CO)
- NURSE III- Clinical Risk Manager Print...of the department's action. For more information about the appeals process, the official appeal form, and how to ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5013009) Apply NURSE III- Clinical Risk Manager Salary $8,369.00 - $11,717.00 Monthly Location… 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
- City and County of San Francisco (San Francisco, CA)
- …Nurse (RN) license issued by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a valid Clinical ... centers. Under general medical and nursing direction, you will perform pediatric clinical nursing duties in hospitals, clinics, and community health centers. As a… more
- LifePoint Health (Hickory, NC)
- *Registered Nurse (RN), Clinical Case Manager* PRN * * *Your experience matters* At Frye Regional Medical Center, we are driven by a profound commitment to ... and harassment in employment." **Job:** **Nursing* **Organization:** ** **Title:** *Registered Nurse (RN), Clinical Case Manager PRN* **Location:** *NC-Hickory*… more
- Stony Brook University (Stony Brook, NY)
- …Medicine's **Advanced Practitioners** are valuable members of our team who provide clinical services to our patient population. We are seeking candidates to work ... minor joint procedures. + Work with clinic staff together for insurance appeals and pre-authorizations as necessary. + Coordination with clinic staff of patient… more
