• RN Clinical Review…

    St. Luke's University Health Network (Allentown, PA)
    …communities we serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
    St. Luke's University Health Network (10/28/25)
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  • Clinical Appeals Reviewer

    AmeriHealth Caritas (Philadelphia, PA)
    …process, preferably within a managed care organization **Licensure:** + Current and unrestricted Registered Nurse ( RN ) licensure or compact state licensure ... **Role Overview: ;** The Clinical Appeals Reviewer is responsible for...appeals , ensuring compliance with all regulatory milestones + Review medical records to identify Hospital-Acquired Conditions (HAC), ensure… more
    AmeriHealth Caritas (10/13/25)
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  • Clinical Appeals Nurse…

    Penn State Health (Hershey, PA)
    …executive orders that prohibit or outlaw discrimination._ **Union:** Non Bargained **Position** Clinical Appeals Nurse - Revenue Integrity Process ... + Bachelor's degree in Nursing required. + Currently licensed to practice as a Registered Nurse by state of employment or holds a multistate RN… more
    Penn State Health (10/24/25)
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  • Associate Manager RN Denials Management

    Banner Health (PA)
    …Requires a level of education as normally demonstrated by a Bachelor's degree. Requires Registered Nurse ( RN ) licensure in the state of practice. Requires ... clinical denials. Collaborates with Care Coordination, physician, Utilization Review , and other internal/external departments to overturn and/or reduction of… more
    Banner Health (11/01/25)
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  • RN Case Manager (Part Time) - West Penn…

    Highmark Health (Pittsburgh, PA)
    **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care and manages ... and contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials/ appeals and retrospective payer audit denials.… more
    Highmark Health (09/13/25)
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  • Psychiatrist

    KidsPeace Childrens Hospital (Schnecksville, PA)
    …as necessary collaboration/supervision agreements with Advance Practice Professionals (Certified Registered Nurse Practitioners or Physician Assistants) and ... and Statistical Manual of Mental Disorders, written treatment orders, admissions on-call review for all legal commitment status documents and review and… more
    KidsPeace Childrens Hospital (10/07/25)
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  • Pediatrician / Family Practice

    KidsPeace Childrens Hospital (Schnecksville, PA)
    …as necessary collaboration/supervision agreements with Advance Practice Professionals (Certified Registered Nurse Practitioners or Physician Assistants) and ... history and physical examination, either written or dictated. This includes a review of the immunization status, allergies, past history, family history and… more
    KidsPeace Childrens Hospital (10/07/25)
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