• RN Clinical Appeals

    Molina Healthcare (Albuquerque, NM)
    JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals ... health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… more
    Molina Healthcare (01/02/26)
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  • Care Review Clinician ( RN )

    Molina Healthcare (Albuquerque, NM)
    For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
    Molina Healthcare (11/23/25)
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  • Director, Clinical Care Services - New…

    Magellan Health Services (Albuquerque, NM)
    …- Care MgmtCare Mgmt, PT - Physical Therapist, State Licensure - Care MgmtCare Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... care. Oversees utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the...policies and processes. Also oversees the health plans 24/7 Nurse Line program and the clinical management… more
    Magellan Health Services (01/08/26)
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