- NHS Management (Prattville, AL)
- …(minimum data set) experience required NHS is seeking an experienced Regional Case Manager/MDS Consultant to add to our team of leaders. In this position you will be ... with the assessment and the plan of care. QUALIFICATIONS Must be a Registered Nurse in good standing in the state(s) in which assigned Must be knowledgeable in… more
- CVS Health (Columbus, OH)
- …all with heart, each and every day. **Position Summary** CVS Aetna is seeking a dedicated ** Appeals Nurse Consultant ** to join our remote team. In this role, ... will be responsible for processing the medical necessity of Medicare appeals for participating providers. **Key Responsibilities** + Requesting clinical, research,… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding ... adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge...Case Manager Upon Hire Preferred + LNCC - Legal Nurse Consultant Certified Upon Hire Preferred **Experience:**… more
- CareFirst (Baltimore, MD)
- …+ CCM - Certified Case Manager Upon Hire Preferred or + LNCC - Legal Nurse Consultant Certified Upon Hire Preferred **Experience:** + 5 years Experience in a ... goals resulting in the full and fair review of appeals and designed to achieve corporate objectives and advance...experience. Master's in Science Nursing or related field, Legal Nurse Consultant , Certified Case Manager. **Knowledge, Skills… more
- CareFirst (Baltimore, MD)
- …& Qualifications** **PURPOSE:** We are looking for a Director, Medical Review & Appeals for our Government Programs lines of business. The incumbent will ensure ... through direction and oversight of the Clinical Medical Claims Reviews, Clinical Appeals and Analysis programs and Quality of Care complaints in conjunction with… more
- State of Indiana (Indianapolis, IN)
- Appeals & Eligibility Specialist Date Posted: Jan 9, 2026 Requisition ID: 466621 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling career ... with continuous, life-long support. Role Overview: The Care Management Consultant 's role is to promote and protect the autonomy...requirements at 42 CFR 483.430, or - A registered nurse in Good Standing with the State of Indiana… more
- State of Colorado (Denver, CO)
- Nurse Consultant , Health Compliance Inspector Acute Care - FAA01510 ( Nurse Consultant ) Print ... Nurse Consultant , Health Compliance Inspector Acute Care - FAA01510 ( Nurse Consultant ) Salary $100,428.00 Annually Location Denver, CO Job Type Full Time… more
- Sacramento County (Sacramento, CA)
- Licensed Vocational Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448956) Apply Licensed Vocational Nurse D/CF Salary ... 4/3/2026, 7/2/2026, 10/2/2026 In a detention/correctional facility, the Licensed Vocational Nurse D/CF performs a wide variety of vocational nursing duties,… more
- Sacramento County (Sacramento, CA)
- Registered Nurse D/CF (Level I/II) Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/454059) Apply Registered Nurse D/CF (Level I/II) ... pm on: 9/4/2025, 11/6/2025, 1/2/2026, 3/5/2026, 5/7/2026, 7/2/2026, 9/3/2026, 11/5/2026 Registered Nurse D/CF Level I: $62.99 - $76.57 hourly Registered Nurse … more
- Community Wellness Partners (Oswego, NY)
- …Maintains open communication with Medical Staff, Administrator, DON, ADON and Pharmacy consultant 23. Attends Nurse Management meetings, Patient Care meetings ... $75K - $85K/Year GENERAL DESCRIPTION: MDS (Minimum Data Set) nurse collects and assesses information for the health and...Issues NOMNC to residents/responsible party and assists with the appeals process, as needed. 20. Completes QA audits as… more
- NHS Management, LLC (Tuscaloosa, AL)
- …with the assessment and the plan of care. QUALIFICATIONS + Must be a Registered Nurse in good standing in the state(s) in which assigned + Must be knowledgeable in ... Regional Administrator, Director of Medicare and Rehabilitation and MDS/Clinical Information Consultant . + Conducts audits to ensure accurate completion of all MDS… more
- Sacramento County (Sacramento, CA)
- …of California to practice as a: Either: 1. Psychiatric Technician Or: 2. Registered Nurse Or: 3. Vocational Nurse Note: The word "experience" referenced in the ... language other than standard English; and/or act as a consultant to others regarding the needs and problems presented...Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days… more
- Centene Corporation (Jefferson City, MO)
- …Develop and maintain the audit process and tools related to: authorizations, appeals , quality events, and case management in CCMS; interrater reliability related to ... and tools + Facilitate compliance with the auditing process + Act as a consultant related to system auditing to others in the unit, department and health plan… more
- City and County of San Francisco (San Francisco, CA)
- …of experience as a Licensed Psychiatric Technician or a Licensed Vocational Nurse providing psychiatric nursing care in a skilled facility or psychiatric acute ... permanent or temporary (including an interim permit) California Licensed Vocational Nurse License or Licensed Psychiatric Technician License. Applicants must meet… more
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