• RN Clinical Review Appeals

    St. Luke's University Health Network (Allentown, PA)
    …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims ... 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 (07/08/25)
    - Related Jobs
  • Registered Nurse ( RN )…

    Avera (Sioux Falls, SD)
    …commercial/managed care payer admission/concurrent level of care denials. + Collaborates with the Clinical Appeals Specialist to ensure tracking and trending ... cause undue hardship to the employer. **Required Education, License/Certification, or Work Experience:** + Registered Nurse ( RN ) - Board of Nursing An active… more
    Avera (08/23/25)
    - Related Jobs
  • 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)
    - Related Jobs
  • Quality & Patient Safety Specialist

    Beth Israel Lahey Health (Cambridge, MA)
    …to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality data by ... on the key performance indicators and quality measures, the RN specialist also aims to foster a...reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review… more
    Beth Israel Lahey Health (08/08/25)
    - Related Jobs
  • Appeals and Grievance Specialist

    Commonwealth Care Alliance (Boston, MA)
    011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
    Commonwealth Care Alliance (08/20/25)
    - Related Jobs
  • 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/4963973) Apply  CDOC Registered Nurse ( Nurse I) Salary $7,591.00 - $10,627.00 Monthly… more
    State of Colorado (06/06/25)
    - Related Jobs
  • Utilization Rev Appeals Spec

    University of Michigan (Ann Arbor, MI)
    …Medicine's Hospital Billing Audits & Appeals (HBAA) Department?** The Audit and Appeals Specialist has a strong knowledge of medical appeal and audit ... They are knowledgeable about insurance requirements and medical billing practices. The Appeals Specialist will collaborate with multiple departments to maintain… more
    University of Michigan (08/19/25)
    - Related Jobs
  • RN Clinical Integration…

    Trinity Health (Des Moines, IA)
    …(https://www.mercyone.org/desmoines/find-a-location/)** Join the MercyOne Family! We are looking to hire a RN Clinical Integration Specialist . The purpose of ... the Clinical Integration Specialist is to assist and support the Director in...Day Shift **General Requirements:** + Iowa licensure as a Registered Nurse . + Member of a professional… more
    Trinity Health (08/08/25)
    - Related Jobs
  • Specialist -Denial II RN

    Baptist Memorial (Memphis, TN)
    …in a payer hearing or clinical meeting when indicated. The Denial Mitigation-Appeal Specialist II RN may have the opportunity to work remotely after 90 days ... Overview Specialist -Denial Mitigation II RN Job Code:...determine next steps. In accordance with the guidelines, the Specialist compiles an appeal along with pertinent clinical more
    Baptist Memorial (07/11/25)
    - Related Jobs
  • Denials Management Specialist ( RN

    St. Luke's University Health Network (Allentown, PA)
    …of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks ... preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending....an accredited, professional nursing program. + Must have current RN license to practice in the state of Pennsylvania… more
    St. Luke's University Health Network (08/13/25)
    - Related Jobs