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4 appeals nurse jobs at 3 companies in Delaware

1mo
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Manager of Clinical Appeals and Grievances
New York or West Virginia or Indiana or Virginia or Tennessee or South Carolina or Pennsylvania or Nevada or New Jersey or North Carolina or Minnesota or Maryland or Massachusetts or Kansas or Illinois or Florida or Delaware or Connecticut or Colorado or New Hampshire or Arizona or Vermont or Alabama or Maine or Utah or Mississippi or Wyoming or Montana or South Dakota or Nebraska or New Mexico or Washington or Oklahoma
$89k-$149k/yr RemoteFull Time
HF Management Services, LLC
HF Management Services, LLC: Management employing staff for Healthfirst, a not-for-profit New York health insurer serving Medicaid, Medicare, and commercial members.
Bachelor's degree or equivalent experience, active RN, experience in utilization management/appeals & grievances, leadership and vendor management, regulatory knowledge and strong communication skills.
InterQual, Milliman
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1w
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Appeals Resolution Analyst II / RN
Hopewell or New Jersey or New York or Pennsylvania or Connecticut or Delaware
$79k-$106k/yr RemoteFull Time
Horizon Blue Cross Blue Shield of New Jersey
Horizon Blue Cross Blue Shield of New Jersey: Not-for-profit New Jersey health insurer providing medical, dental, vision, and prescription coverage to individuals, employers, and public programs.
2+ YOERequires RN license, 2 years clinical experience, and 3 years in the healthcare delivery system or industry. High school diploma/GED required; healthcare management bachelor's degree preferred. Utilization management knowledge required.
personal computer
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3w
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Appeals Resolution Analyst II-RN
Hopewell or New York or Pennsylvania or Connecticut or Delaware
$79k-$106k/yr RemoteFull Time
Horizon Blue Cross Blue Shield of New Jersey
Horizon Blue Cross Blue Shield of New Jersey: Not-for-profit New Jersey health insurer providing medical, dental, vision, and prescription coverage to individuals, employers, and public programs.
2+ YOERequires RN license, 2 years of clinical experience, 3 years in healthcare delivery, high school diploma/GED, utilization management knowledge, strong communication, negotiation, judgment, and problem-solving skills.
personal computer
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4d
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Clinical Pre-Service Nurse Coordinator - Days
Conshohocken or Wilmington or Darby or Philadelphia or Langhorne
OnsiteFull Time
Trinity Health Mid-Atlantic
Trinity Health Mid-Atlantic: Nonprofit Catholic health system serving Greater Philadelphia through four hospitals, outpatient care, home health, and senior programs.
2+ YOERequires Pennsylvania RN or LPN/LVN license, accredited nursing education, 2+ years nursing and pre-certification or clinical denial management experience; revenue cycle, coding, and appeal knowledge preferred.
Epic Prelude, Epic Resolute, ICD-9, CPT, HCPCS
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