• Clinical Appeals Supervisor

    R1 RCM (Detroit, MI)
    …conduct a comprehensive review of clinical denials and formulate appeals based on clinical documentation, evidence-based medical necessity criteria, ... identify targeted areas for additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay… more
    R1 RCM (07/18/25)
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  • Clinical Appeals Nurse ( RN )

    Molina Healthcare (Sterling Heights, MI)
    …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of previously ... **JOB DESCRIPTION** For this position we are seeking a ( RN ) Registered Nurse who must...for the state they reside This position will support Medical Review for Medicare and Marketplace request… more
    Molina Healthcare (08/02/25)
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  • Clinical Manager - Provider Appeals (Hybrid…

    Henry Ford Health System (Troy, MI)
    …by the Clinical Director, Appeals and Grievance. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse with current Michigan licensure + Bachelor's Degree in ... methodologies. Additional Information + Organization: HAP (Health Alliance Plan) + Department: Medical Appeals + Henry Ford Health Location: HAP (Health Alliance… more
    Henry Ford Health System (08/02/25)
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  • RN Utilization Management Coordinator PRN

    Corewell Health (Southfield, MI)
    …2 years of relevant experience 2 years of experience in clinical/hospital setting. Required + Registered Nurse ( RN ) - State of Michigan Upon Hire required ... reviews. Coordinates activities involved in the certification, recertification, and concurrent appeals process, conducting referrals for 2nd level review , as… more
    Corewell Health (07/31/25)
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  • RN Care Coordinator

    Corewell Health (Royal Oak, MI)
    …in care management, utilization review , home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan License Upon Hire ... for patients utilizing hospital outpatient, observation or inpatient services. 4. May review cases for medical necessity, uses InterQual and/or other UR/UM… more
    Corewell Health (06/27/25)
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  • Infusion Referral Nurse - REMOTE

    Prime Therapeutics (Lansing, MI)
    …Patient Programs. **Education & Experience** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings and consults with...for work visa or residency sponsorship. **Additional Qualifications** + Registered Nurse ( RN ). + 5… more
    Prime Therapeutics (07/24/25)
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