• RN Clinical Review Appeals

    St. Luke's University Health Network (Allentown, PA)
    …we serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
    St. Luke's University Health Network (10/28/25)
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  • Clinical Denials Prevention & Appeals

    Nuvance Health (Danbury, CT)
    *Description* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within the first 12-24 hours ... notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the...* Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum of… more
    Nuvance Health (12/25/25)
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  • Appeals Audit Specialist - McLaren…

    McLaren Health Care (Mount Pleasant, MI)
    …of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and achieve optimal ... other related duties as required and directed. **Qualifications:** **_Required:_** + Registered Health Information Technician (RHIT), Licensed Practical Nurse more
    McLaren Health Care (11/11/25)
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  • 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 ... reviews of previously denied cases in which a formal appeals request has been made or upon request by...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
    Molina Healthcare (01/02/26)
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  • Clinical Appeals and Disputes Nurse

    University of Washington (Seattle, WA)
    …changes impacting revenue cycle **REQUIREMENTS** + Active licensure to practice as a Registered Nurse in Washington State + Bachelor's degree in Nursing + ... Medicine's Patient Financial Services Department** has an outstanding opportunity for a **Clinical Appeals and Disputes Nurse .** **WORK SCHEDULE** + 100% FTE +… more
    University of Washington (12/19/25)
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  • CDOC Registered Nurse ( Nurse

    State of Colorado (CO)
    CDOC Registered Nurse ( Nurse I) Print...RN license. 07 Do you possess an active RN license issued by an Enhanced Nurse Licensure ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5123731) Apply  CDOC Registered Nurse ( Nurse I) Salary $7,591.00 - $10,627.00 Monthly… more
    State of Colorado (11/11/25)
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  • Registered Nurse Care Coordinator-…

    Cedars-Sinai (CA)
    …as a condition of continued employment. **Req ID** : 13443 **Working Title** : Registered Nurse Care Coordinator- Inpatient Specialty Program - 8 Hour Days $5K ... Investigates, processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate policy. + Begins… more
    Cedars-Sinai (01/01/26)
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  • Denial RN DRG Appeal Writer1 / HIM Coding

    Hartford HealthCare (Farmington, CT)
    …management and appeals preferred. **Licensure, Certification, Registration** * Active Registered Nurse license from the State of Connecticut * Certified ... and other common practices across the system. *_Position Summary:_* The Denial Specialist is responsible for reviewing, analyzing and appealing denials related to… more
    Hartford HealthCare (11/26/25)
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  • PRN Clinical Utilization Review Specialist

    Community Health Systems (Franklin, TN)
    …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital… more
    Community Health Systems (12/03/25)
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  • Utilization Review Specialist

    TEKsystems (Los Angeles, CA)
    …adjudication. This role is ideal for a Licensed Vocational Nurse (LVN) or Registered Nurse ( RN ) with hands-on experience in Utilization Management (UM) ... Participate in special projects related to claim denials and appeals Required Qualifications: + Active LVN or RN... appeals Required Qualifications: + Active LVN or RN license (California) + 2+ years of experience in… more
    TEKsystems (12/31/25)
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