• 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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  • Clinical Appeals Nurse…

    CareFirst (Baltimore, MD)
    **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes ... regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all applicable State and Federal… more
    CareFirst (01/06/26)
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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 (Austin, TX)
    …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... **RN Strongly Preferred - Compact RN License Required** **100% Remote ** **Schedule: 8:00 am - 6:00 pm CST either...- Saturday or Sunday - Thursday** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals… more
    Centene Corporation (01/07/26)
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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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  • Appeals RN - Care Management Full- time…

    Providence (Torrance, CA)
    …responsible for providing overall management and communication of clinically-based appeals between Providence Health and Services, California Region (PH&S) outside ... Qualifications:** + Associate's Degree - Nursing. + California Registered Nurse License upon hire. + 2 years - Direct...certification upon hire. + Experience working with denials and appeals in/for an acute care setting. + Experience in… more
    Providence (01/07/26)
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  • Clinical Denials & Appeals…

    Northwell Health (Melville, NY)
    …+ Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect ... retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness… more
    Northwell Health (01/07/26)
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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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