• Clinical Appeals Nurse…

    Molina Healthcare (Bowling Green, KY)
    … 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 (05/16/25)
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  • Appeals Nurse

    Evolent (Frankfort, KY)
    …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
    Evolent (05/10/25)
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  • Appeals Nurse Consultant - Remote…

    CVS Health (Frankfort, KY)
    …8a-5p in time zone of residence **Monday - Friday.** **Position Summary** The Appeals Nurse Consultant position is responsible for processing the medical ... necessity of Medicare appeals for participating providers. Primary duties may include, but...on the computer. **Required Qualifications** + 3+ years of clinical experience required + Active and unrestricted RN… more
    CVS Health (05/22/25)
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  • RN Medical Claim Review Nurse

    Molina Healthcare (Covington, KY)
    …resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical ... state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
    Molina Healthcare (05/21/25)
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