• Nurse Appeals RN

    Elevance Health (Durham, NC)
    ** Nurse Appeals ** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and...would provide an equivalent background. + Current active unrestricted RN license to practice as a health professional within… more
    Elevance Health (09/03/25)
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  • Registered Nurse ( RN…

    LifePoint Health (Hickory, NC)
    …to prioritize your well-being so you can provide exceptional care to others. As a Registered Nurse ( RN )**joining our team, you're embracing a vital mission ... payer guidelines and discharge financial implications. * Manages denial appeals and chart audit reviews. *7. Case Management* *...medical equipment, and facility transfers. *How you'll contribute* A Registered Nurse ( RN )**who excels in… more
    LifePoint Health (08/28/25)
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  • Registered Nurse ( RN…

    LifePoint Health (Hickory, NC)
    …to prioritize your well-being so you can provide exceptional care to others. As a Registered Nurse ( RN )**joining our team, you are embracing a vital mission ... home health, hospice, medical equipment, and facility transfers. *How you will contribute* A Registered Nurse ( RN )**who excels in this role: * Accurately… more
    LifePoint Health (08/09/25)
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  • Clinical Audit and Appeals Consultant

    Intermountain Health (Raleigh, NC)
    **Job Description:** The RCO Audit & Appeals RN Consultant is responsible for consulting on clinical Appeals and Audits for Intermountain Health. The Audit/ ... Appeals RN Consultant will execute clinical audits of medical records...institution. Education is verified + Current licensure as a registered nurse required. + Experience in Microsoft… more
    Intermountain Health (09/08/25)
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  • Infusion Referral Nurse Sr- REMOTE

    Prime Therapeutics (Raleigh, NC)
    …Patient Programs. **Minimum Qualifications** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings and consults with...for work visa or residency sponsorship **Additional Qualifications** + Registered Nurse ( RN ). + 5… more
    Prime Therapeutics (09/04/25)
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  • Clinical Denials Coordinator

    UNC Health Care (Goldsboro, NC)
    …licensure. Experience * Minimum 7-10 years of applied clinical experience as a Registered Nurse required. * Minimum 3-5 years of applied clinical experience ... Advisors and subject matter experts for all audit and appeals work activities. Assists with documentation review to support...as a Registered Nurse required. * 2 years utilization… more
    UNC Health Care (08/14/25)
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  • Director Utilization Management

    Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
    …groups and clinical committees. Essential Qualifications + Active and unrestricted license as a Registered Nurse ( RN ). + Bachelor's degree in nursing, (or ... team consisting of Clinicians and Non-Clinical support staff from Intake through Appeals processing. The ideal candidate will have a strong clinical background… more
    Brighton Health Plan Solutions, LLC (07/18/25)
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  • Clinical Case Manager

    LifePoint Health (Rutherfordton, NC)
    …implications of discharge plans.5. Follows up with any denials through the appeals process; including RAC chart audit reviews. Emergency Department (ED) Case ... may extend length of stay.4. Communicates positively with physicians, nurse leaders and ED staff.5. Actively observes the way...a stressful environment and take appropriate action. *Licenses:* Current RN license to practice in NC (NC licensure or… more
    LifePoint Health (08/09/25)
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