• Appeals Nurse

    Evolent (Pierre, SD)
    …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 (12/24/25)
    - Related Jobs

  • Clinical Registered Nurse - Utilization…

    Cognizant (Pierre, SD)
    …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 (12/23/25)
    - Related Jobs

  • Utilization Management - Nurse Manager

    Sanford Health (Rapid City, SD)
    …interaction with payers. Additional duties include management of medical denials, appeals , and grievances. Understand and provide insight into evaluating current ... Experience in medical necessity review preferred. Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing and/or possess… more
    Sanford Health (12/17/25)
    - Related Jobs

  • Family Health Advocate - Remote

    Sharecare (Pierre, SD)
    …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 (12/13/25)
    - Related Jobs