• Clinical Appeals Nurse…

    Molina Healthcare (San Antonio, TX)
    … 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 (Austin, TX)
    **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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  • Clinical Liaison - NeuroTransitional Center…

    Select Medical (Dallas, TX)
    …and valid state licensure or eligibility for state licensure as a Registered Nurse , Physical Therapist, Occupational Therapist, or Speech Language Pathologist ... joint venture with Select Medical & Baylor Scott & White Health Dallas, TX ** Clinical Liaison ( RN strongly preferred)** **Full-Time, Monday through Friday 8am -… more
    Select Medical (09/04/25)
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  • Medical Claim Review Nurse ( RN )

    Molina Healthcare (San Antonio, TX)
    …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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  • Infusion Referral Nurse Sr- REMOTE

    Prime Therapeutics (Austin, TX)
    …visa or residency sponsorship **Additional Qualifications** + Registered Nurse ( RN ). + 5 years of post-degree clinical experience. + Experience in ... these cases in web-based application and spreadsheets. + Supports clinical services such as the appeals program....+ Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State… more
    Prime Therapeutics (09/04/25)
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  • Senior Denials Mgmt Specialist

    Houston Methodist (Sugar Land, TX)
    …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or...care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge… more
    Houston Methodist (07/31/25)
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