- Premera Blue Cross (Mountlake Terrace, WA)
- …or four (4) years' work experience (REQUIRED) + Current State Licensure as a registered nurse (REQUIRED) + Three (3) years of clinical experience (REQUIRED) + ... Healthsource blog: https://healthsource.premera.com/ . The **Care Coordinator** - **Clinical Appeals ** performs prospective review (benefit advisory/ prior authorization) admission,… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is seeking a highly motivated and results-driven **UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical ... to ensure consistent clinical evaluation and processing of medical necessity appeals . Accurate documentation and detailed recordkeeping of notifications to members… more
- Stanford Health Care (Palo Alto, CA)
- …180 Days or + CCDS - Cert Clinical Document Spec required within 180 Days + RN - Registered Nurse - State Licensure And/Or Compact State Licensure required ... the Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and denials. This position requires strong… more
- Jobleads-US (New York, NY)
- …excellence in patient care and staff support. Requirements Active New York State (NYS) Registered Nurse ( RN ) License. Strong knowledge of Certified Home ... Quality Management RN Brooklyn, NY Monday - Friday 8:30 am...Contribute to continuous performance improvement initiatives. Prepare and manage appeals processes. Track and manage grievances. Analyze patient satisfaction… more
- Alameda Health System (San Leandro, CA)
- …AHA-American Heart Association. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. **PAY RANGE** ... SLH Case Manager RN + San Leandro, CA + San Leandro...contacts with payers conducting phone reviews and initiates denial appeals as needed. + Encourages patients to develop realistic… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …appeals and acquire authorizations for treatment **Key Qualifications:** + Current NYS Registered Nurse License/Registration and BSN preferred + At least 2-3 ... support Oncology Patients? The MSK Case Management Department is made up of Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and support staff. In this… more
- Commonwealth Care Alliance (Boston, MA)
- …Referral and authorization; Regulatory compliance; Billing and payments; Complaints and appeals ; Policies and procedures. + Identify opportunities for training and ... record, (if applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer.… more
- Commonwealth Care Alliance (Boston, MA)
- …setting preferred - Prior experience with service authorizations, grievances and appeals , scheduling medical appointments preferred - Ability to work with multiple ... record, (if applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer.… 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 ... + Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and… more
- State of Colorado (Denver, CO)
- …(HP III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5112485) Apply Registered Nurse Health Compliance Inspector Home Care - ... health, safety, and well-being of Colorado communities. As a Registered Nurse ( RN ) Health Professional...Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel… more
- State of Colorado (Denver, CO)
- …III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5084845) Apply Registered Nurse , Health Compliance Inspector, Complaints ... Registered Nurse , Health Compliance Inspector, Complaints...Section - FAA00710 (HP III RN ) Salary $80,916.00 Annually Location Denver, CO Job Type… more
- State of Colorado (Denver, CO)
- …III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5120373) Apply Registered Nurse Health Compliance Inspector, Nursing ... Registered Nurse Health Compliance Inspector, Nursing...Facilities - FAA00221 (HP III RN ) Salary $80,916.00 Annually Location Denver, CO Job Type… more
- Walgreens (Deerfield, IL)
- …for customers, patients, team members and communities. **Job ID:** 1655228BR **Title:** Registered Nurse ( RN ) Specialty **Company Indicator:** Walgreens ... to defined medications. Evaluates all requests for prior authorizations, appeals and accompanying tasks. + Provides nursing network subject...Associate's degree in Nursing + Current license/registration as an RN ( Registered Nurse ) with the… more
- St. Luke's University Health Network (Allentown, PA)
- …Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. . ... of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding… more
- Sacramento County (Sacramento, CA)
- Supervising Registered Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448883) Apply Supervising Registered Nurse ... are at 5:00 pm on: 2/3/25, 4/7/25, 6/2/25, 8/4/25, 10/6/25, 12/1/25 Supervising Registered Nurse - Detention/Correctional Facility is the first level supervisory… more
- Sacramento County (Sacramento, CA)
- …read and understood the above instructions. 02 Select the one box that best describes your Registered Nurse ( RN ) license issued by the State of California. + ... Registered Nurse D/CF (Level I/II) Print...Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days… more
- State of Colorado (Pueblo, CO)
- Nurse I - Registered Nurse ...if your application is eliminated. You will find the appeals process, the official appeal form, and how to deliver ... - CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5101894) Apply Nurse I - Registered Nurse I - CMHHIP Salary $43.80 - $61.31… more
- Commonwealth Care Alliance (Boston, MA)
- …complexities that require intensive care management and care delivery. Within the CIC Program, the Registered Nurse ( RN ) serves as an integral member of an ... and based on the fluctuating needs of the defined panel of members, the Registered Nurse will engage in regular assessments, visits at regularly scheduled… 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 ... listed. + Description + Benefits + Questions Department Information Registered Nurse II-Full Time CMHHIP This posting...if your application is eliminated. You will find the appeals process, the official appeal form, and how to… 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...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
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