• Clinical Appeals Nurse (RN)

    Molina Healthcare (GA)
    …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... with internet connectivity of high speed required **Job Summary** Clinical Appeals is responsible for making appropriate...more of the following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist more
    Molina Healthcare (08/02/25)
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  • RN Clinical Review Appeals

    St. Luke's University Health Network (Allentown, PA)
    …serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
    St. Luke's University Health Network (07/08/25)
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  • Clinical Nurse Specialist

    City and County of San Francisco (San Francisco, CA)
    …and assists with designing and implementing plans for meeting such needs. The Clinical Nurse Specialist performs other related duties as assigned/required. ... by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
    City and County of San Francisco (07/25/25)
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  • Pediatrics Clinical Nurse

    City and County of San Francisco (San Francisco, CA)
    Nurse (RN) license issued by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a valid Clinical ... general medical and nursing direction, you will perform pediatric clinical nursing duties in hospitals, clinics, and community health...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
    City and County of San Francisco (07/16/25)
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  • Registered Nurse or Physical Therapist…

    CenterWell (Honolulu, HI)
    …caring community and help us put health first** The **Denials Management Specialist ** is responsible to respond to, monitor and analyze all governmental requests, ... to, managing and monitoring all payer requests for additional documentation (ADR), appeals and denials. Works with branch staff to gather required information and… more
    CenterWell (07/30/25)
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  • UR Clinical Specialist

    Community Health Systems (Franklin, TN)
    **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
    Community Health Systems (07/29/25)
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  • RN Clinical Integration Specialist

    Trinity Health (Des Moines, IA)
    …Join the MercyOne Family! We are looking to hire a RN Clinical Integration Specialist . The purpose of the Clinical ... requirements that improve outcomes and reduce harm to patients. The specialist works closely with ministry colleagues, providers, and leaders in implementing,… more
    Trinity Health (06/11/25)
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  • Senior Denials Mgmt Specialist

    Houston Methodist (Sugar Land, TX)
    …management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of care for ... and billing processes, managed care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of CPT and ICD… more
    Houston Methodist (07/31/25)
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  • Registered Nurse (RN), Clinical Case…

    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 ... and harassment in employment." **Job:** **Nursing* **Organization:** ** **Title:** *Registered Nurse (RN), Clinical Case Manager PRN* **Location:** *NC-Hickory*… more
    LifePoint Health (07/16/25)
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  • Insurance Specialist -Mount Sinai…

    Mount Sinai Health System (New York, NY)
    …for appeals , On / Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days...Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status… more
    Mount Sinai Health System (07/23/25)
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