• Clinical Appeals Supervisor…

    CareFirst (Baltimore, MD)
    **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate implementation of the clinical appeal process ... and serves as a resource for associates within the Clinical Appeals and Analysis unit. We are...who is willing and able to work in a hybrid model. The incumbent will be expected to work… more
    CareFirst (10/15/25)
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  • Supervisor , Clinical Grievance…

    Centene Corporation (New York, NY)
    …appeals and grievances from a clinical perspective. Ensure that the clinical Appeals and Grievance department processes all cases in accordance with ... changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene...holidays, and a flexible approach to work with remote, hybrid , field or office work schedules. Actual pay will… more
    Centene Corporation (10/31/25)
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  • Lead Customer Solution Center Appeals…

    LA Care Health Plan (Los Angeles, CA)
    …in Nursing for Registered Nurses Experience Required: At least 8 years of clinical appeals and grievances experience in a managed care, utilization management ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical...achieve regulatory standards. Acts as a back-up to the Supervisor in leading meetings and handling escalations as required.… more
    LA Care Health Plan (11/11/25)
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  • Authorization and Denial Supervisor…

    Trinity Health (Albany, NY)
    **Employment Type:** Full time **Shift:** Day Shift **Description:** **Authorization and Denial Supervisor - Hybrid - Must be local to Albany,NY** **Summary** ... office procedures and pharmaceuticals including off label drugs, and drugs for clinical trials. **Job Duties and Responsibilities** + Leads efforts to ensure staff… more
    Trinity Health (11/13/25)
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  • Psychologist I - Forensic Evaluator - Statewide…

    State of Colorado (Denver, CO)
    PSYCHOLOGIST I - Forensic Evaluator - Statewide ( Hybrid ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5001467) Apply  PSYCHOLOGIST I - ... Forensic Evaluator - Statewide ( Hybrid ) Salary $7,945.00 - $9,534.00 Monthly Location Denver, CO...to inform their opinion and seeks consultation from their supervisor or colleagues on difficult, complex, or ambiguous cases.… more
    State of Colorado (10/11/25)
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  • Certified Coding Supervisor - Health…

    Ventura County (Ventura, CA)
    Certified Coding Supervisor - Health Information Management Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4892159) Apply  Certified Coding ... Supervisor - Health Information Management Salary $94,952.15 - $132,946.07...Information Management (HIM) department related to coding and CDI ( clinical documentation improvement). The ideal candidate will have a… more
    Ventura County (11/24/25)
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  • Supervisor , Payment Integrity

    Centene Corporation (Jefferson City, MO)
    …fresh perspective on workplace flexibility. **Position Purpose:** Responsible for leading clinical coding compliance nurses and non- clinical team members through ... + Identifies and implements best practices and operational efficiencies + Researches clinical and coding questions and issues + Triages and resolves escalated health… more
    Centene Corporation (09/27/25)
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  • Member Appeal Analyst

    Corewell Health (Grand Rapids, MI)
    …State and Federal decisions are properly implemented. Assist the Lead, Supervisor and/or Manager in coordinating activities and in the development/collection of ... Essential Functions + Responsible for complex and thorough investigation of appeals , external complaints, and fair hearing reviews including: formulate action plan… more
    Corewell Health (11/26/25)
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  • Registered Nurse Health Compliance Inspector Home…

    State of Colorado (Denver, CO)
    …As a Registered Nurse (RN) Health Professional III , you will use your clinical expertise to ensure quality of care, protect patient rights, and promote excellence ... with state and federal standards; + Assessing nursing and clinical services for adherence to accepted professional practice; +...Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel… more
    State of Colorado (11/26/25)
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  • Psychologist I - Evaluator Court Services - Pueblo

    State of Colorado (CO)
    …to receive text message updates on CDHS recruiting events! CDHSCareers Description of Job Hybrid Work: This position is required to report to the office at least 2x ... and competencies necessary to the position through continuing education, clinical supervision, literature review, and discipline and team development. This… more
    State of Colorado (11/28/25)
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