- Commonwealth Care Alliance (Boston, MA)
- …and driving record, (if applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an equal opportunity ... responsible for cultivating, maintaining and strengthening relationships with the Commonwealth Care Alliance's (CCA) provider community. In this highly visible field… 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
- Evolent (Springfield, IL)
- …as an RN - **Required** + Minimum of 5 years in Utilization Management , health care Appeals , compliance and/or grievances/complaints in a quality ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...Doing:** + Practices and maintains the principles of utilization management and appeals management by… more
- State of Colorado (Denver, CO)
- …Registered Nurse , Health Compliance Inspector Home Care - FAA00601 (HP III RN ) Print ... Apply Registered Nurse , Health Compliance Inspector Home Care - FAA00601 (HP III RN ) Salary $80,916.00 Annually Location Denver,… more
- LA Care Health Plan (Los Angeles, CA)
- …the ability to manage multiple training initiatives simultaneously. Licenses/Certifications Required Licensed Registered Nurse ( RN ) - Active, current and ... Lead Customer Solution Center Appeals and Grievances RN Job Category:... appeals and grievances experience in a managed care , utilization management and/or case management… more
- Rochester Regional Health (Rochester, NY)
- Job Title: Registered Nurse I Department: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 hours (Full-Time) Schedule: Monday - ... managed care payment principles helpful + Case Management Certification + At least 3 years RN...Support - American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse -… more
- Molina Healthcare (WI)
- 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
- State of Colorado (Denver, CO)
- …III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5190465) Apply Registered Nurse Health Compliance Inspector, Complaints ... Registered Nurse Health Compliance Inspector, Complaints...Section - FAA00731 (HP III RN ) Salary $80,916.00 Annually Location Denver, CO Job Type… more
- State of Colorado (Golden, CO)
- Registered Nurse I, RN ...to: healthy lifestyle ie diet, exercise, sleep hygiene, stress management , proper hygiene practices, dental care , STI's ... Mountain, Youth Services Center - Golden Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5185059) Apply Registered Nurse I, RN I -… more
- St. Luke's University Health Network (Allentown, PA)
- …the communities we serve, regardless of a patient's ability to pay for health care . The RN Clinical Review Appeals Specialist retrospectively reviews patient ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Director Pre Appeals Management -HSO Appeals Management -Corporate 42nd Street-Full-Time-Days -Remote** The Director, Pre Appeals ... leader who provides strategic leadership and operational oversight for the hospital's pre- appeals management program. This role ensures the appropriate use of… more
- Nuvance Health (Danbury, CT)
- …in Milliman and InterQual Guidelines required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum of ... *Description* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions...and communicating on a daily/regular basis with the Denials Management team. * Assists with informing Managed Care… more
- BronxCare Health System (Bronx, NY)
- …documents all telephone communications in accordance with department procedures using Care Management and other resources, escalates issues related to ... department physician advisors and clinical staff. Qualifications - NYS Registered Nurse required - The Appeal Manager...On the job or formal training in certified case management , denial and appeals management … more
- Sacramento County (Sacramento, CA)
- Supervising Registered Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448883) Apply Supervising Registered Nurse ... 5:00 pm on: 12/1/25, 2/2/26, 4/6/26, 6/1/26, 8/3/26, 10/5/26, 12/7/26 Supervising Registered Nurse - Detention/Correctional Facility is the first level… more
- University of Washington (Seattle, WA)
- …changes impacting revenue cycle **REQUIREMENTS** + Active licensure to practice as a Registered Nurse in Washington State + Bachelor's degree in Nursing + ... Medicine's Patient Financial Services Department** has an outstanding opportunity for a **Clinical Appeals and Disputes Nurse .** **WORK SCHEDULE** + 100% FTE +… more
- State of Colorado (Pueblo, CO)
- Nurse I - Registered Nurse I - CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5187654) Apply Nurse I - Registered ... closing date and time listed. + Description + Benefits + Questions Department Information Registered Nurse I-Full Time CMHHIP This posting will be used to fill… more
- CareFirst (Baltimore, MD)
- …complications. **QUALIFICATIONS:** **Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis,...Management at CareFirst BlueCross BlueShield, or similar Managed Care organization or hospital. + BSN/MSN Degree. **Knowledge, Skills… more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... process for our membership, and support NCQA accreditation and the Divisional Goals for Care Management . We are looking for an experienced clinical leader in the… more
- CareFirst (Baltimore, MD)
- …in addition to the required work experience. **Licenses/Certifications Upon Hire Required:** + RN - Registered Nurse - State Licensure And/or Compact ... and oversight of the Clinical Medical Claims Reviews, Clinical Appeals and Analysis programs and Quality of Care...State Licensure. **Experience:** 8 years clinical experience in care management . 3 years' experience leading in… more
- State of Colorado (Pueblo, CO)
- Registered Nurse II- CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5187078) 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
