• Clinical Appeals Nurse…

    Molina Healthcare (Albany, NY)
    … 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 (08/15/25)
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  • Clinical Audit and Appeals…

    Intermountain Health (Albany, NY)
    **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...institution. Education is verified + Current licensure as a registered nurse required. + Experience in Microsoft… more
    Intermountain Health (09/08/25)
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  • Medical Claim Review Nurse ( RN )

    Molina Healthcare (Albany, NY)
    …hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical … more
    Molina Healthcare (09/06/25)
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  • Discharge Planner

    Ellis Medicine (Schenectady, NY)
    …and assist in utilization management activities under the direction of a registered nurse and/or social worker. Responsibilities include maintaining case files, ... primary function is to work with the Social Worker, Nurse Case Manager, or Utilization Management Nurse ...information per policy. + Assists Utilization Management with initial clinical review requests as needed. + Notifies Case Manager… more
    Ellis Medicine (08/28/25)
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