• Clinical Appeals Nurse (RN)

    Molina Healthcare (GA)
    …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously ... For this position we are seeking a (RN) Registered Nurse who must be licensed for the state they...they reside This position will support Medical Review for Medicare and Marketplace request authorization. Strongly prefer candidates with… more
    Molina Healthcare (08/02/25)
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  • Clinical Manager - Provider Appeals (Hybrid…

    Henry Ford Health System (Troy, MI)
    …of provider appeals , for all product lines (HMO, AHL, and Medicare Advantage (MA), Medicaid, and Duals) in accordance with internal HAP policies. Coordinate ... and Center for Medicare /Medicaid Services (CMS). Maintain formal history of provider appeals and the medical component of Member appeals to utilize for… more
    Henry Ford Health System (08/02/25)
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  • Medicare Sales Account Representative

    BrightSpring Health Services (Louisville, KY)
    …issues. Refer all unresolved issues to the next level including grievance and appeals . + Actively market plan to new senior care partners within plan Service ... approved sales and marketing presentations in accordance with applicable Centers for Medicare & Medicaid Services (CMS) and State guidelines and standards. + Conduct… more
    BrightSpring Health Services (07/02/25)
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  • Registered Nurse or Physical Therapist…

    CenterWell (Honolulu, HI)
    …experience in working with Payer requirements, both traditional Medicare and Medicare Advantage plans, ADR requests, Denials, Appeals , TPE, RCD, RAC, ZPIC, ... to, managing and monitoring all payer requests for additional documentation (ADR), appeals and denials. Works with branch staff to gather required information and… more
    CenterWell (07/30/25)
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  • Utilization Review Nurse

    US Tech Solutions (Columbia, SC)
    …authorization requests for Medicare Advantage line of business. Previous Medicare experience and /or UR experience/Process Appeals requests/can have ... Interactive team works with multiple applications to process authorization and appeals requests using Medicare criteria. **Responsibilities:** + Reviews and… more
    US Tech Solutions (07/31/25)
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  • Assistant Nurse Manager - Nurse III…

    State of Colorado (Denver, CO)
    Assistant Nurse Manager - Nurse III - Colorado Mental Health Hospital in Fort Logan (S. Denver) Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5012615) Apply  Assistant Nurse Manager - Nurse III - Colorado Mental Health Hospital in Fort… more
    State of Colorado (07/19/25)
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  • Registered Nurse I - Nursing Residency…

    State of Colorado (Pueblo, CO)
    Registered Nurse I - Nursing Residency Program - CMHHIP - Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5007135) Apply  Registered ... Nurse I - Nursing Residency Program - CMHHIP -...Hospital Accreditation Standards, Environment of Care Manual, Centers for Medicare and Medicaid Services, Safety Data Sheets, Colorado State… more
    State of Colorado (07/16/25)
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  • Nurse I - Veterans Community Living Center…

    State of Colorado (Garfield County, CO)
    NURSE I - Veterans Community Living Center at Rifle Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4907915) Apply  NURSE I - Veterans ... & Appeal Rights Education/Licensure/Certification/Experience: Current, valid licensure as a Registered Nurse from the Colorado Board of Nursing or any state… more
    State of Colorado (07/17/25)
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  • Registered Nurse I, RN I - Campus…

    State of Colorado (Golden, CO)
    Registered Nurse I, RN I - Campus at Lookout Mountain, Youth Services Center - Golden Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5019028) ... Apply  Registered Nurse I, RN I - Campus at Lookout Mountain,...name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure… more
    State of Colorado (07/25/25)
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  • Registered Nurse (RN) - Utilization…

    Rochester Regional Health (Rochester, NY)
    Job Title: Registered Nurse IDepartment: Utilization Management Location: Rochester General Hospital Hours Per Week: 40 hours (Full-Time)Schedule: Monday - Friday, ... concurrent (as needed) and retrospective reviews. The Utilization Management Nurse will act as a resource on denial management...UM review findings, initiate and 1st, 2nd, and/or arbitration appeals as needed. Document in all areas that an… more
    Rochester Regional Health (08/02/25)
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