• Registered Nurse Denial

    McLaren Health Care (Grand Blanc, MI)
    …duties as required and directed. **Qualifications:** _Required_ + State licensure as a registered nurse (RN) + Bachelor's degree in nursing from accredited ... with physicians, other team members, payers, and administrators regarding denial and appeals cases reviews and process....or utilization review experience + Five years of clinical nurse experience in an acute care setting + American… more
    McLaren Health Care (10/02/25)
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  • Appeals Audit Specialist - McLaren Careers

    McLaren Health Care (Mount Clemens, MI)
    …auditors . Provides support to both internal and external customers for denial / appeals activities and audits. Assists with monitoring and auditing activities, ... requests for medical record documentation and the filing of responses and appeals . 1. Appropriately documents denial /appeal activities; oversees and documents… more
    McLaren Health Care (09/26/25)
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  • Appeals Manager

    BronxCare Health System (Bronx, NY)
    …special projects and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate ... the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to… more
    BronxCare Health System (09/19/25)
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  • Regional Manager Denial Management…

    McLaren Health Care (Grand Blanc, MI)
    …**_Required:_** + Associate's degree in nursing or healthcare related field **.** Current Registered Nurse license in the state of Michigan or possess a ... practice standards. 5. Assists with managing the revenue cycle by reducing clinical denial write offs 6. Assists in running reports and utilizes tools for reporting… more
    McLaren Health Care (09/26/25)
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  • Registered Nurse - Utilization…

    Beth Israel Lahey Health (Plymouth, MA)
    …+ Collaborates with the multidisciplinary team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR ... Manager and/or physician advisor regarding cases that do not meet established guidelines for admission or continued stay. + Acts as a liaison between physicians and payers, coordinating peer-to-peer phone calls. + Collects and compiles data as required. _It is… more
    Beth Israel Lahey Health (08/16/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Warren, MI)
    …will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing clinical knowledge and ... and audit details in the database + Provides supporting documentation for denial and modification of payment decisions + Independently re-evaluates medical claims… more
    Molina Healthcare (09/06/25)
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  • Revenue Integrity Nurse Auditor

    Childrens Hospital of The King's Daughters (Chesapeake, VA)
    …duties as assigned. + LICENSES AND/OR CERTIFICATIONS + Current Virginia state license as a Registered Nurse or Registered Nurse holding a valid Compact ... + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and...supporting documentation, as well as facilitates the completion of appeals in a timely manner. + Prepares trend and… more
    Childrens Hospital of The King's Daughters (07/24/25)
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  • Senior Denials Mgmt Specialist

    Houston Methodist (Sugar Land, TX)
    …and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure - Must ... is responsible for performing utilization review activities, and monitoring the clinical denial management and appeals process, as applicable, in collaboration… more
    Houston Methodist (07/31/25)
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  • AVP Care Coordination

    Nuvance Health (Danbury, CT)
    …in nursing, health administration, or a related field preferred * Current licensure as a registered nurse (RN) * Minimum of 5 years of clinical experience in an ... lengths of stay, enhanced organizational efficiency, and maximized reimbursement through denial reduction and successful appeals . The *System Care Coordination… more
    Nuvance Health (09/10/25)
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  • Case Manager - Case Management

    Arnot Health (Elmira, NY)
    denial errors, types and recurring issues. 4. Facilitates, coordinates and prepares denial appeals working with internal and external customers in a proactive ... Auth/ Denial Management meetings EDUCATION: RN required. EXPERIENCE: NYS licensed Registered Nurse required. Bachelor's in nursing preferred. Must have… more
    Arnot Health (08/08/25)
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