• Nurse Appeals - Medicare

    Elevance Health (Tampa, FL)
    ** Nurse Appeals - Medicare** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... an accommodation is granted as required by law. The ** Nurse Appeals - Medicare** is responsible for...would provide an equivalent background. + Current active unrestricted RN license to practice as a health professional within… more
    Elevance Health (07/23/25)
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  • Clinical Appeals Nurse Reviewer

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    …help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound clinical judgement to ... integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a...to assist with medical necessity determinations. Key Qualifications: + Registered Nurse with an active unrestricted professional… more
    Blue Cross Blue Shield of Massachusetts (06/26/25)
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  • Clinical Appeals Nurse

    R1 RCM (Boise, ID)
    …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Nurse ** , you will help our hospital clients by ... **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review...at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position,… more
    R1 RCM (07/10/25)
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  • Clinical Appeals Nurse ( RN )

    Molina Healthcare (Midvale, UT)
    **JOB DESCRIPTION** _For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state of UTAH or have a compact license._ _This ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of… more
    Molina Healthcare (07/20/25)
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  • Appeals Nurse Consultant

    CVS Health (Hartford, CT)
    …time zone) with occasional weekends and holidays on a rotation schedule. The Appeals Nurse Consultant position is responsible for processing the medical ... necessity of Medicare Part C appeals from both members and providers. This role is...a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,… more
    CVS Health (07/23/25)
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  • Registered Nurse Clinical…

    Intermountain Health (West Valley City, UT)
    …medical necessity of the admission. Reports to the Director of Audit and Appeals in the Revenue Integrity Department. ESSENTIAL DUTIES AND RESPONSIBILITIES 1. Uses ... write up clinical reviews for insurance audits and governmental insurance appeals using supporting documentation. 2. Assesses the appropriateness of clinical appeal… more
    Intermountain Health (07/24/25)
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  • Registered Nurse , Complaints Health…

    State of Colorado (Denver, CO)
    …(HP III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5010527) Apply  Registered Nurse , Complaints Health Compliance Inspector - ... Registered Nurse , Complaints Health Compliance Inspector -...FAA00438 (HP III RN ) Salary $80,916.00 - $90,648.00 Annually Location Denver, CO Job… more
    State of Colorado (07/19/25)
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  • Registered Nurse Health Compliance…

    State of Colorado (Denver, CO)
    …(HP III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5019261) Apply  Registered Nurse Health Compliance Inspector Home Care - ... Registered Nurse Health Compliance Inspector Home Care -...FAA00094 (HP III RN ) Salary $80,916.00 Annually Location Denver, CO Job Type Full Time… more
    State of Colorado (07/25/25)
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  • Registered Nurse I, RN I…

    State of Colorado (Golden, CO)
    Registered Nurse I, RN I...of the department's action. For more information about the appeals process, the official appeal form, and how to deliver ... Mountain, Youth Services Center - Golden Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5019028) Apply  Registered Nurse I, RN I -… more
    State of Colorado (07/25/25)
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  • Registered Nurse ( RN

    LifePoint Health (Hickory, NC)
    * Registered Nurse ( RN ), Clinical Case Manager* PRN * * *Your experience matters* At Frye Regional Medical Center, we are driven by a profound commitment to ... valued as an employee, but as a person. As a* registered nurse ( RN )*joining our team,...payer guidelines and discharge financial implications. * Manages denial appeals and chart audit reviews. *7. Case Management** Acts… more
    LifePoint Health (07/16/25)
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