- CVS Health (Lansing, MI)
- …all with heart, each and every day. **Position Summary** CVS Aetna is seeking a dedicated ** Appeals Nurse Consultant ** to join our remote team. In this role, ... a critical role in ensuring fair and accurate resolution of clinical appeals by applying sound clinical judgment and regulatory knowledge. **Key Responsibilities** +… more
- CareFirst (Baltimore, MD)
- …+ CCM - Certified Case Manager Upon Hire Preferred + LNCC - Legal Nurse Consultant Certified Upon Hire Preferred Salary Range: $78,696 - $162,311 **Salary ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate implementation of the clinical appeal process for members… more
- State of Colorado (Pueblo, CO)
- Nurse I - RN Critical Incident/Occurrence Reporter-CMHHIP-Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5147450) Apply Nurse I - ... + Description + Benefits + Questions Department Information Registered Nurse I-Full Time CMHHIP This position has a residency...context both for this position's assigned workload, and as consultant to the Occurrence Team overall. + Using the… more
- Sacramento County (Sacramento, CA)
- Licensed Vocational Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448956) Apply Licensed Vocational Nurse D/CF Salary ... 4/3/2026, 7/2/2026, 10/2/2026 In a detention/correctional facility, the Licensed Vocational Nurse D/CF performs a wide variety of vocational nursing duties,… more
- Sacramento County (Sacramento, CA)
- Registered Nurse D/CF (Level I/II) Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/454059) Apply Registered Nurse D/CF (Level I/II) ... pm on: 9/4/2025, 11/6/2025, 1/2/2026, 3/5/2026, 5/7/2026, 7/2/2026, 9/3/2026, 11/5/2026 Registered Nurse D/CF Level I: $62.99 - $76.57 hourly Registered Nurse … more
- TEKsystems (Orlando, FL)
- …ERISA and state mandates. + Provide insight to management on consultant quality, availability, and compliance with policies/procedures. + Promote efficient ... $31.50/hr | LPN: $29/hr Utilization Management (2 Openings) Responsibilities: + Review appeals and all types of Prior Authorizations. + Conduct Admissions reviews… more
- City and County of San Francisco (San Francisco, CA)
- …Independent Medical Evaluators) on complex cases. 12. Works collaboratively with the Occupational Nurse Consultant , Nurse Manager, and/or Nurse Case ... claims and establish medical protocols. 13. Advises the Occupational Nurse Manager and/or Consultant on issues related...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… more
- NHS Management, LLC (Tuscaloosa, AL)
- …with the assessment and the plan of care. QUALIFICATIONS + Must be a Registered Nurse in good standing in the state(s) in which assigned + Must be knowledgeable in ... Regional Administrator, Director of Medicare and Rehabilitation and MDS/Clinical Information Consultant . + Conducts audits to ensure accurate completion of all MDS… more
- Sacramento County (Sacramento, CA)
- …of California to practice as a: Either: 1. Psychiatric Technician Or: 2. Registered Nurse Or: 3. Vocational Nurse Note: The word "experience" referenced in the ... language other than standard English; and/or act as a consultant to others regarding the needs and problems presented...Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days… more
- Centene Corporation (Jefferson City, MO)
- …Develop and maintain the audit process and tools related to: authorizations, appeals , quality events, and case management in CCMS; interrater reliability related to ... and tools + Facilitate compliance with the auditing process + Act as a consultant related to system auditing to others in the unit, department and health plan… more