• Specialist - Denial II…

    Baptist Memorial (Memphis, TN)
    …* Position may be filled in Memphis, TN; Jackson , MS The Denial Mitigation-Appeal Specialist II RN serves in a key role of the BMHCC revenue cycle ... resolution in order to defend our revenue. The Denial Mitigation-Appeal Specialist II RN reviews the denial received from the payer, completes… more
    Baptist Memorial (07/11/25)
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  • Utilization Management Nurse…

    LA Care Health Plan (Los Angeles, CA)
    Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II...health plan compliance with UM or CM. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
    LA Care Health Plan (07/08/25)
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  • MassHealth Regulatory Compliance & Audits…

    Commonwealth Care Alliance (Boston, MA)
    …Claims Operations & Quality Assurance, the Regulatory Compliance & Audits Sr. Specialist II is responsible for ensuring CCA's operational compliance with ... to compliance inquiries from internal teams regarding benefit design, denial logic, or claims workflows. * Assist in the...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
    Commonwealth Care Alliance (06/02/25)
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