• Clinical Appeals Nurse…

    Molina Healthcare (Detroit, MI)
    … 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 (08/15/25)
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  • RN Provider Appeals Coordinator…

    Henry Ford Health System (Troy, MI)
    …Alliance Plan (HAP) is looking to grow our Medical Appeals Team with an experienced Registered Nurse ! We are a team of Registered Nurses (3 and counting) ... RN PROVIDER APPEALS COORDINATOR - MEDICAL...Microsoft Word. Excel and Access preferred. CERTIFICATIONS/LICENSURES REQUIRED: + Registered Nurse ( RN ) with current… more
    Henry Ford Health System (09/10/25)
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  • Clinical Appeals Supervisor

    R1 RCM (Detroit, MI)
    …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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  • Medical Claim Review Nurse ( RN )

    Molina Healthcare (Detroit, MI)
    …hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical … more
    Molina Healthcare (09/06/25)
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  • Utilization Management Nurse Supervisor

    Integra Partners (Troy, MI)
    …priorities, systems, and workflows in a fast-paced environment. EDUCATION: Active, unrestricted Registered Nurse , Licensed Vocational Nurse , or Licensed ... The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership...InterQual, CMS, health plan policies). + Review and process clinical and administrative appeals ; coordinate with Medical… more
    Integra Partners (08/26/25)
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  • RN Care Coordinator

    Corewell Health (Royal Oak, MI)
    …experience in care management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan License Upon ... criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization… more
    Corewell Health (08/25/25)
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  • RN Care Coordinator

    Corewell Health (Farmington Hills, MI)
    …experience in care management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan Upon Hire ... criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization… more
    Corewell Health (08/25/25)
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