• Clinical Appeals Supervisor

    R1 RCM (Salt Lake City, UT)
    …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Supervisor** , you will help support clinicians ... position. **Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor...for additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position,… more
    R1 RCM (08/31/25)
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  • Clinical Appeals Nurse

    Molina Healthcare (Omaha, NE)
    … decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
    Molina Healthcare (08/20/25)
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  • Clinical Audit and Appeals

    Intermountain Health (Denver, CO)
    **Job Description:** The RCO Audit & Appeals RN Consultant is responsible for consulting on clinical Appeals and Audits for Intermountain Health. The ... Audit/ Appeals RN Consultant will execute clinical audits of...institution. Education is verified + Current licensure as a registered nurse required. + Experience in Microsoft… more
    Intermountain Health (09/08/25)
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  • Clinical Review Clinician - Appeals

    Centene Corporation (Oklahoma City, OK)
    …Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + RN - Registered Nurse - State Licensure ... have RN Compact license **Position Purpose:** Performs clinical reviews needed to resolve and process appeals... requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent… more
    Centene Corporation (09/10/25)
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  • RN Clinical Denials Appeals

    CommonSpirit Health Mountain Region (Centennial, CO)
    …with resources to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management ... will need the following: Required Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with… more
    CommonSpirit Health Mountain Region (09/10/25)
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  • Registered Nurse ( RN

    LA Care Health Plan (Los Angeles, CA)
    Registered Nurse ( RN ) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & ... presentations. Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and… more
    LA Care Health Plan (09/09/25)
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  • Appeals and Grievances Clinical

    Healthfirst (NY)
    …OR Dental Hygienist Preferred Qualifications: + Bachelors degree + Experience in clinical practice with experience in appeals & grievances, claims processing, ... and Responsibilities:** + Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity,… more
    Healthfirst (09/09/25)
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  • Utilization and Appeals Manager

    Catholic Health Services (Melville, NY)
    …Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals ... Responsibilities include but not limited to: Receives, manages and provides clinical reviews and/or submissions as required by contractual or regulatory… more
    Catholic Health Services (07/24/25)
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  • Inpatient Clinical & Coding Specialist…

    Independent Health (Buffalo, NY)
    …coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with ... Coder (CIC), Registered Health Information Management Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Clinical Documentation… more
    Independent Health (07/15/25)
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  • Senior Denials Mgmt Specialist

    Houston Methodist (Sugar Land, TX)
    …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or...care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge… more
    Houston Methodist (07/31/25)
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