• Appeals Nurse Consultant (Remote)

    CVS Health (Columbus, OH)
    …with heart, each and every day. **Position Summary** CVS Aetna is seeking a dedicated ** Appeals Nurse Consultant** to join our remote team. In this role, you ... computer. + Responsible for the review and resolution of clinical appeals . + Reviews documentation and interprets...permitted. **Required Qualifications** + Must have active and unrestricted RN licensure in state of residence. + 3+ years… more
    CVS Health (01/03/26)
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  • Appeals Nurse

    Evolent (Columbus, OH)
    …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
    Evolent (12/24/25)
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  • Manager II Grievance/ Appeals RN

    Elevance Health (Independence, OH)
    **Manager II Grievance/ Appeals - RN ** **Location** : Ohio-Cincinnati, Columbus, Mason, or Seven Hills ( _Must be within commutable distance to one of the listed ... contracts, benefits, clinical decisions, pharmacy on pre-service and post service appeals and grievances related to non- clinical and clinical services,… more
    Elevance Health (01/09/26)
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  • Director, Home Health Grievances & Appeals

    CenterWell (Columbus, OH)
    …to preserve and recover revenue while maintaining the highest level of clinical and regulatory integrity and compliance. Manages the Denials Management data ... and appeal process. The Director, Home Health Grievances & Appeals assists members, via phone or face to face,...+ Oversee the process for direction and support to clinical and operational leadership regarding Medicare and governmental audit… more
    CenterWell (01/08/26)
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  • Care Review Clinician ( RN )

    Molina Healthcare (OH)
    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 (12/24/25)
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  • Medical Review Nurse ( RN )- Remote

    Molina Healthcare (OH)
    …and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/ appeals . + Provides training and support to clinical peers. +… more
    Molina Healthcare (01/09/26)
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  • Director of Home Health Authorizations,…

    CenterWell (Columbus, OH)
    …revenue integrity and patient access. The Director partners closely with clinical leadership, operations, finance, compliance, and IT, and manages both onshore ... onshore and offshore teams. * Coordinate closely with Intake, Clinical Operations, Scheduling, Billing, and Denials teams. ** Clinical...Teams * Revenue Cycle Leadership * Billing, Denials, and Appeals Teams * Compliance, Legal, and Audit * IT… more
    CenterWell (01/08/26)
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