11 Clinical Appeals Nurse jobs

California, United States (Remote)

$27.00 – $49.00 / hour

Position Purpose: Facilitate medical necessity grievance, appeals and denials including disposition of denials notification letters, review of…

United States (Remote)

$68–113K / year

Job Family : Clinical Appeals Nurse Travel Required : None Clearance Required : None What You Will Do : Conduct pre‑ and post‑service medical…

Harrisburg, Pennsylvania, US (Hybrid)

Category: Health Care Location: Harrisburg Pennsylvania United States Are you a registered nurse ready to take your career in an exciting new…

United States (Remote)

Overview HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an…

United States (Remote)

$82.7–96.5K / year

Job Description A bit about this role: The Clinical Guide Part A will be part of the Utilization Management team, responsible for inpatient,…

Harrisburg, Pennsylvania, US (Hybrid)

Category: Health Care Location: Harrisburg Pennsylvania United States Seeking a Registered Nurse (RN) – Expert Medical Examination Consultant to…

United States (Remote)

$73–125K / year

Job Description A bit about this role: The Clinical Readmission Manager is responsible for conducting prepayment and post-payment clinical reviews of…

United States (Remote)

As a Senior Review Coordinator RN , you will be responsible for conducting utilization review/medical management for all services, including…

United States (Remote)

Description WHO WE ARE: GlobalHealth is a fast-growing Medicare Advantage HMO health insurer.

South Carolina, United States (Remote)

Summary Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or…

Oklahoma, United States (Remote)

$87–161.3K / year

Position Purpose: Manages Prior Authorization, Concurrent Review, Retrospective Review Clinical Review and/or Appeals team to ensure appropriate care to members.