• Appeals Nurse

    Evolent (Santa Fe, NM)
    …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
    Evolent (10/11/25)
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  • Registered Nurse - Clinical Appeals…

    Cognizant (Santa Fe, NM)
    …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
    Cognizant (10/09/25)
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  • RN Medical Claim Review Nurse Remote

    Molina Healthcare (Albuquerque, NM)
    JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring timely claims payment ... with knowledge of CPT/HCPCS codes, record review, chart audit, provider disputes, appeals , and 1500 & UB04 claim experience are highly preferred. Ability to… more
    Molina Healthcare (10/19/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Las Cruces, NM)
    …will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing clinical knowledge and ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical peers. +… more
    Molina Healthcare (09/06/25)
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  • Medical Director (AZ)

    Molina Healthcare (Roswell, NM)
    …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends… more
    Molina Healthcare (10/17/25)
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  • Family Health Advocate - Remote

    Sharecare (Santa Fe, NM)
    …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
    Sharecare (10/14/25)
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