• Cottage Health (Goleta, CA)
    …seeks a Utilization Review Manager, Registered Nurse for their Clinical Denials and Appeals department responsible for the overall management of ... and staff. The manager actively manages, maintains and communicates clinical denials and appeals activity to appropriate...Preferred: 2 years direct patient care experience as an RN in an acute care setting. About Us Cottage… more
    Upward (07/23/25)
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  • NewYork-Presbyterian Hospital (Brooklyn, NY)
    …an average of 60-70 medical/surgical daily admissions that requires risk identification and clinical reviews. A utilization nurse completes no less than 20 ... (United States of America) Description: Discover Where Amazing Works Case Manager - RN - Inpatient Units- Brooklyn Methodist - Days Located in Park Slope, Brooklyn,… more
    Upward (06/29/25)
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  • Clinical Management Consultants (Escondido, CA)
    …of Emergency Services focuses on coaching and mentoring employees to uphold clinical excellence, including guiding RN Manager Emergency teams through ongoing ... recognized and award-winning Hospital is actively interviewing for a Nurse Manager to lead the Emergency Services Department. This...of services, many of which have been recognized for clinical excellence, this medical center has earned its strong… more
    Upward (07/06/25)
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  • AHMC Healthcare (Daly City, CA)
    Overview QUALIFICATIONS/JOB REQUIREMENTS: EDUCATION: CERTIFICATIONS/LICENSURE: Current California Registered Nurse License in good standing Current BLS ... in an acute care setting preferred. Working knowledge of current clinical , regulatory, accrediting, and third-party payor standards (ie Medicare, MediCal, and… more
    Upward (07/01/25)
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  • Clinical Appeals Nurse

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    Ready to help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound ... an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will...to assist with medical necessity determinations. Key Qualifications: + Registered Nurse with an active unrestricted professional… more
    Blue Cross Blue Shield of Massachusetts (06/26/25)
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  • Clinical Appeals Nurse

    Molina Healthcare (Midvale, UT)
    … decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical ... **JOB DESCRIPTION** _For this position we are seeking a ( RN ) Registered Nurse who must...with internet connectivity of high speed required._ **Job Summary** Clinical Appeals is responsible for making appropriate… more
    Molina Healthcare (07/20/25)
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  • Clinical Appeals Nurse

    R1 RCM (Boise, ID)
    …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help our ... position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct...at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position,… more
    R1 RCM (07/10/25)
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  • Registered Nurse - Clinical

    Guidehouse (Huntsville, AL)
    **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** The **R** **emote** ... ** Clinical Denials RN ** is responsible for review,...Necessity Reviews + Ensure documentation integrity + Construct warranted appeals + Coordinate pre-service authorization approvals **Duties and Responsibilities:**… more
    Guidehouse (07/14/25)
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  • Registered Nurse ( RN

    LifePoint Health (Hickory, NC)
    * Registered Nurse ( RN ), Clinical Case Manager* PRN * * *Your experience matters* At Frye Regional Medical Center, we are driven by a profound commitment ... prohibiting discrimination and harassment in employment." **Job:** **Nursing* **Organization:** ** **Title:** * Registered Nurse ( RN ), Clinical Case… more
    LifePoint Health (07/16/25)
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  • Registered Nurse , Complaints Health…

    State of Colorado (Denver, CO)
    …(HP III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5010527) Apply  Registered Nurse , Complaints Health Compliance Inspector - ... Registered Nurse , Complaints Health Compliance Inspector -...FAA00438 (HP III RN ) Salary $80,916.00 - $90,648.00 Annually Location Denver, CO Job… more
    State of Colorado (07/19/25)
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