• RN Clinical Appeals Nurse…

    Molina Healthcare (WI)
    JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals ... a plus. Work hours: Monday - Friday 8:00am- 5:00pm Remote position **Essential Job Duties** * Performs clinical...reviews of previously denied cases in which a formal appeals request has been made or upon request by… more
    Molina Healthcare (01/02/26)
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  • Registered Nurse (RN) Manager,…

    LA Care Health Plan (Los Angeles, CA)
    Registered Nurse (RN) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & Grievances ... (A&G) & General Operations ( Clinical ) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals & Grievances… more
    LA Care Health Plan (12/09/25)
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  • Clinical Appeals and Disputes…

    University of Washington (Seattle, WA)
    …**WORK SCHEDULE** + 100% FTE + 100% Remote + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ensures that payers are prepared to ... Financial Services Department** has an outstanding opportunity for a ** Clinical Appeals and Disputes Nurse .**...communicated payer decisions in a timely manner + Review clinical denials and initiate appeals process +… more
    University of Washington (12/19/25)
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  • Appeals Nurse Consultant…

    CVS Health (Columbus, OH)
    …each and every day. **Position Summary** CVS Aetna is seeking a dedicated ** Appeals Nurse Consultant** to join our remote team. In this role, you will be ... computer. + Responsible for the review and resolution of clinical appeals . + Reviews documentation and interprets...PM (local time). + No weekends or holidays required. ** Remote Work Expectations** + This is a 100% … more
    CVS Health (01/03/26)
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  • Clinical Review Clinician - Appeals

    Centene Corporation (Indianapolis, IN)
    …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by… more
    Centene Corporation (01/06/26)
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  • Clinical Denials Prevention…

    Nuvance Health (Danbury, CT)
    *Description* *FULL TIME DAY SHIFTS- VARIABLE HOURS / WEEKEND ROTATIONS REQUIRED* * *Hybrid/ Remote * * *Summary:* The purpose of the Denial Prevention Nurse is to ... in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
    Nuvance Health (12/10/25)
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  • Lead Customer Solution Center Appeals…

    LA Care Health Plan (Los Angeles, CA)
    …in Nursing for Registered Nurses Experience Required: At least 8 years of clinical appeals and grievances experience in a managed care, utilization management ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017… more
    LA Care Health Plan (11/11/25)
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  • Clinical Auditor/Analyst Intermediate…

    UPMC (Pittsburgh, PA)
    …for Clinical Auditor/Analysts. + Provide new-hire training to Clinical Auditor/Analysts. Performing administrative appeals /preparing medical necessity ... UPMC Health Plan has an exciting opportunity for a Clinical Auditor/Analyst Intermediate! The Clinical Auditor/Analyst Intermediate is an integral part of the… more
    UPMC (01/06/26)
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  • Utilization Management Nurse - LPN/LVN

    Integra Partners (Troy, MI)
    …of UM authorization reviews, both verbally and in writing + Process administrative and clinical appeals and refer as needed to the Medical Director + Maintain ... care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key role in collaborating… more
    Integra Partners (11/21/25)
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  • Charge Nurse RN II - CO Mental Health…

    State of Colorado (Denver, CO)
    Charge Nurse RN II - CO Mental Health Hospital in Fort Logan (S. Denver) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5185912) Apply  Charge ... Nurse RN II - CO Mental Health Hospital in...coordinates and implements medical and psychiatric crisis intervention in clinical emergencies assuring compliance with nursing standards and policies/procedures.… more
    State of Colorado (01/06/26)
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