• RN Medical Claim…

    Molina Healthcare (Layton, UT)
    …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... **Job Duties** + Performs clinical/ medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which… more
    Molina Healthcare (05/21/25)
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  • Registered Nurse , Case Manager…

    CVS Health (Salt Lake City, UT)
    …- Perform medical necessity reviews. **Required Qualifications** - 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience in ... of residence.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS...a hospital setting. - A Registered Nurse that holds an active, unrestricted… more
    CVS Health (05/16/25)
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  • NY Registered Nurse - Case Manager 2

    Public Consulting Group (Salt Lake City, UT)
    …sector. To learn more, visit www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case Manager ... Proven working experience in case management, including as a nurse , medical , mental health care manager or...plans. + Current license, certification or registration as a Registered Nurse or Social Worker **Working Conditions**… more
    Public Consulting Group (04/05/25)
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  • Investigator, SIU RN -Remote

    Molina Healthcare (UT)
    …to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. ... nursing experience with broad clinical knowledge. + Five years experience conducting medical review and coding/billing audits involving professional and facility… more
    Molina Healthcare (04/12/25)
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  • Clinical Appeals Nurse ( RN )

    Molina Healthcare (Provo, UT)
    …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of… more
    Molina Healthcare (05/16/25)
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  • RN Clinical Consultant

    Guardian Life (Salt Lake City, UT)
    …providing comprehensive medical reviews and analysis of long-term disability claims . The RN Clinical Consultant identifies restrictions, limitations and ... duration impacting functional capacity based on medical data, to assist the Claim Managers...The RN Clinical Consultant reviews long-term disability claims to determine the impact of claimants' medical… more
    Guardian Life (05/06/25)
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  • Clinical Coding Appeals Nurse

    R1 RCM (Salt Lake City, UT)
    …working as a Clinical Coding Appeals Nurse :** + Review and interpret medical records to appeal denied and underpaid claims . + Apply clinical judgment and ... and underpaid claims . Every day you will review medical records to ensure appropriate coding...external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + An active CCS,… more
    R1 RCM (05/21/25)
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  • Appeals Hearing Specialist

    Intermountain Health (West Valley City, UT)
    …assist attorneys/physician advisors 2) Participates through representation in formal grievance hearings, medical review boards and courts of law 3) Educates ... works closely with Intermountain Health legal team, Physician Advisors, and Appeals RN consultants in their various capacities. ​ Fully remote position! +… more
    Intermountain Health (05/13/25)
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  • Consultant, Nurse Disability

    Lincoln Financial (Salt Lake City, UT)
    …as indicated **What we're looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where the ... organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you… more
    Lincoln Financial (04/30/25)
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  • Clinical Appeals Nurse

    R1 RCM (Salt Lake City, UT)
    …experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical records and payer denial information submitted by clients ... appeals.Represent clients at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay… more
    R1 RCM (05/20/25)
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