- Molina Healthcare (Rio Rancho, NM)
- JOB DESCRIPTION **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal ... a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/ appeals . + Provides training and support to clinical peers. +… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- Position is On-Site The Behavioral Health Nurse - Managed Care is responsible for coordinating, monitoring, and delivering behavioral health services within a ... in utilization of resources, avoidable days/denials. Works in collaboration with Appeals Management/Medical Director in the appeals process. + Responsible… more
- Community Wellness Partners (Oswego, NY)
- WAGE RATE - $75K - $85K/Year GENERAL DESCRIPTION: MDS (Minimum Data Set) nurse collects and assesses information for the health and well-being resident in Medicare ... MDS sections. Follows facility policy and procedures. The MDS Nurse monitors residents' health and well-being from the time...Issues NOMNC to residents/responsible party and assists with the appeals process, as needed. 20. Completes QA audits as… more
- Cummins Behavioral Health Systems Inc. (Avon, IN)
- …organization, Cummins is your kind of place. * If being part of a learning organization appeals to you, get in touch with us. * If you seek an employer with ethical ... in multiple counties throughout central and west central Indiana. The Advanced Practice Nurse , under the supervision of a Staff Psychiatrist, will augment our staff… more
- Omaha Children's Hospital (Omaha, NE)
- …be considered. Children's Nebraska has an exciting opportunity to join our ** Nurse Practitioner Critical Care** **Transport** team! Our **Pediatric Nurse ... helicopter and a Pilatus PC-12 fixed-wing aircraft. The Pediatric Nurse Practitioner Transport Provider is responsible for managing the...activities and is home to a world-class zoo that appeals to children and adults alike. Greater Omaha has… more
- Guthrie (Binghamton, NY)
- …in basket monitoring, overdue results, referrals, provider orders and support the nurse navigator role. Experience: A minimum of 2 years' experience preferred in ... state in which the position resides. Licenses: Licensed Practical Nurse in the state of position. Essential Functions: Patient...of coverage of ordered medications. + Coordinate and complete appeals for denials as needed + Monitor and Review… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- **12/2/2025 - REVISED FTE *_SUMMARY:_* We are currently seeking a*Staff Nurse *to join our Utilization Management department for the/Emergency Department / This ... Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical necessity, appropriateness,… more
- Omaha Children's Hospital (Omaha, NE)
- …Children's Nebraska has an exciting opportunity to join our **Neonatal Nurse Practitioner** **Transport** team! Our NNPs work collaboratively with flight nurses ... of Nebraska offers a unique opportunity for a Neonatal Nurse Practitioner (NNP) to join our dedicated neonatal transport...activities and is home to a world-class zoo that appeals to children and adults alike. Greater Omaha has… more
- City and County of San Francisco (San Francisco, CA)
- …+ Administers nursing care to patients according to physician's and Registered Nurse 's instructions and approved nursing and departmental policies and procedures; as ... by nursing service policy. + The 2312 Licensed Vocational Nurse may perform other duties as assigned/required + LICENSE:...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- System One (Baltimore, MD)
- Job Title: Clinical Medical Review Nurse Location: Baltimore, MD 21224 Type: Contract, 5 mos with chance of extension Compensation: Based on experience starting at ... travel to providers for record retrieval, as needed. Clinical Medical Review Nurse / Medical Records Abstraction Specialist Schedule: 8-hour shifts (start time 8:00… more