- 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 ... and Fair Hearing processes + Coordinate: Ensures continuity of care needs are met and advocates on behalf of...+ 3+ years Nursing experience + 1+ years Utilization Management and Appeals experience + Excellent verbal,… 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 preferred ... (United States of America) **This is a Stanford Health Care job.** **A Brief Overview** Clinical Government Audit Analyst...plays a critical role in the Revenue Cycle Denials Management Department by managing and resolving clinical appeals… more
- 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
- Providence (Torrance, CA)
- **Description** ** Appeals RN - Care Manager...Degree Nursing. + Upon hire: California Registered Nurse License. + 2 years Direct patient care ... Per Diem and will work 8-hour, Day shifts.** The Care Management Recovery Advocate (CMRA) is responsible...management certification. + Experience working with denials and appeals in/for an acute care setting. +… more
- MVP Health Care (Schenectady, NY)
- …terminology, healthcare procedures, and clinical guidelines. + Previous experience in clinical appeals , utilization management or managed care and LTSS ... At MVP Health Care , we're on a mission to create a...To achieve this, we're looking for a **Professional, Clinical Appeals RN ** to join #TeamMVP. This is… 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
- McLaren Health Care (Grand Blanc, MI)
- …including role, responsibilities tools, and methodologies. _Required:_ + State licensure as a Registered Nurse ( RN ) + Bachelor's degree in nursing from ... experience + Five years of clinical nurse experience in an acute care setting + American Case Management Certification (ACM) or obtain certification when… 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
- 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
- Walgreens (Deerfield, IL)
- …for customers, patients, team members and communities. **Job ID:** 1655228BR **Title:** Registered Nurse ( RN ) Specialty **Company Indicator:** Walgreens ... to: Infusion Care , Fertility Order, Nursing Network, Care Management . + May have other responsibilities...Associate's degree in Nursing + Current license/registration as an RN ( Registered Nurse ) with the… more
- Molina Healthcare (Salt Lake City, UT)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal appeals clinical processes - ensuring that appeals ... to overarching strategy to provide quality and cost-effective member care . Candidates with UM and Appeals experience...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Commonwealth Care Alliance (Boston, MA)
- … care management and care delivery. Within the CIC Program, the Registered Nurse ( RN ) serves as an integral member of an interdisciplinary team ... committees and workgroups that promote clinical excellence. The CIC RN May also conduct ** Care Management... management , including: + 5+ years' experience as Registered Nurse in a high touch clinical… 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
- 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
- State of Colorado (Pueblo, CO)
- Registered Nurse I - Nursing Residency...care within a safe and secure environment. The RN Residency Program is a one-year program that encompasses ... Program - CMHHIP - Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5145740) Apply Registered Nurse I - Nursing Residency Program -… more
- Cognizant (Annapolis, MD)
- …expectations. **What you need to have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact... management experience with managed health care plan . 3 years' experience in health … more
- CommonSpirit Health (Centennial, CO)
- …to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison ... BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive experience in utilization review,… more
- HCA Healthcare (Nashville, TN)
- …VA). Do you want to join an organization that invests in you as a Clinical Appeals Specialist Medicare RN or LPN? At Parallon, you come first. HCA Healthcare has ... and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. +...a difference. We are looking for a dedicated Clinical Appeals Specialist Medicare RN or LPN like… more
- State of Colorado (Pueblo, CO)
- Nurse I - Registered Nurse I - CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5130579) 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
- McLaren Health Care (Port Huron, MI)
- …related duties as required and directed. **Qualifications:** Required ⦁ State licensure as a registered nurse ( RN ) ⦁ Bachelor's degree in nursing from ... entry for timeliness, appropriateness and completeness as pertains to the utilization management process including level of care , medical necessity, and… more
