• Clinical Review Clinician - Appeals

    Centene Corporation (Jefferson City, MO)
    …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... preferred. Knowledge of utilization management processes preferred. **License/Certification:** RN - Registered Nurse - State Licensure and/or Compact State… more
    Centene Corporation (10/30/25)
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  • Clinical Registered Nurse…

    Cognizant (Jefferson City, MO)
    …need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and… more
    Cognizant (10/07/25)
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  • Associate Manager RN Denials Management

    Banner Health (MO)
    …a level of education as normally demonstrated by a Bachelor's degree. Requires Registered Nurse (RN) licensure in the state of practice. Requires experience ... from federal, state and commercial reimbursement programs. Provides leadership in clinical , financial, and personnel management within the department to result in… more
    Banner Health (11/01/25)
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  • Supervisor, Payment Integrity

    Centene Corporation (Jefferson City, MO)
    …code editing software systems in a managed care organization preferred. **Certifications:** RN - Registered Nurse or LPN - Licensed Practical Nurse - State ... fresh perspective on workplace flexibility. **Position Purpose:** Responsible for leading clinical coding compliance nurses and non- clinical team members through… more
    Centene Corporation (09/27/25)
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  • Manager, Utilization Review

    Children's Mercy Kansas City (Kansas City, MO)
    …+ Experience in Utilization Review + One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire + One of the ... review functions utilizing InterQual and/or MCG screening guidelines, and clinical denials/ appeals oversight. Participates in department and...following: Licensed RN - Kansas, Registered Nurse Multistate License Kansas required upon… more
    Children's Mercy Kansas City (09/16/25)
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  • Fraud Investigator

    Blue KC (Kansas City, MO)
    …Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI) + Medical License: Registered Nurse (RN), Licensed Practical Nurse (LPN), pharmacist, ... data analytics to identify trends, patterns, outliers relative to peers and clinical standards, etc. In conjunction with the Manager and/or Senior Investigator,… more
    Blue KC (10/16/25)
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