12 appeals nurse jobs at 7 companies in Hackensack, NJ
1w
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Senior Grievance & Appeals Specialist, Clinical
New York City, New York, United States
$93k-$117k/yr OnsiteFull Time
3+ YOENew York RN license required; 3 years healthcare experience, including 2 years in grievance and appeals or medical/utilization management. Requires Microsoft Office proficiency; nursing bachelor's or master's degree preferred.
Microsoft Office, Microsoft Word, Microsoft Excel
2mo
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Managed Care Authorization & Appeals Coordinator
Brooklyn, New York, United States
$20-$25/hr OnsiteFull Time
0+ YOEExperience with insurance authorizations, clinical documentation, Medicare notices, and appeals; collaboration with nursing, rehabilitation, social services, and billing teams.
1mo
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Appeals and Grievances Clinical Specialist
New York City or Lake Mary or New York or New Jersey or Connecticut
$73k-$120k/yr RemoteFull Time
Active RN required; BLS/CPR required, ACLS preferred; experience in clinical practice and appeals & grievances or utilization review; knowledge of Utilization Review guidelines; proficiency with Word/Excel and care management systems.
Microsoft Word, Microsoft Excel, Macess, CCMS, TruCare, Hyland, InterQual, Milliman
3mo
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Precertification & Pre-Service Appeals Nurse
Princeton, New Jersey, United States
$65k-$85k/yr HybridFull Time
2+ YOERN or LPN license in NJ; 2-3 years nursing; 1-2 years in precertification/case management; associate or bachelor degree; detail-oriented with strong communication.
4w
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Appeals and Grievances Clinical Specialist/ Quality Of Care
New York or New York City or Lake Mary
$73k-$120k/yr RemoteFull Time
Active RN required; experience in appeals & grievances, utilization review, or case management preferred; familiarity with utilization guidelines and ability to manage large caseloads under regulatory timeframes.
Microsoft Word, Microsoft Excel, Macess, CCMS, TruCare, Hyland, InterQual, Milliman
1mo
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Appeals and Grievances Clinical Specialist/ Quality Of Care
New York City or Lake Mary
$83k-$120k/yr HybridFull Time
Active RN required; experience in clinical practice and appeals & grievances, claims processing, utilization review or case management; knowledge of utilization review guidelines and ability to manage large caseloads.
Microsoft Word, Microsoft Excel, Macess, CCMS, TruCare, Hyland, InterQual, Milliman
1mo
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Appeals and Grievances Clinical Specialist
New York City or Lake Mary or New York or North Dakota or Indiana or Virginia or Texas or Tennessee or South Carolina or Pennsylvania or Ohio or Nevada or New Jersey or North Carolina or Minnesota or Maryland or Massachusetts or Kansas or Illinois or Iowa or Georgia or Florida or Delaware or Connecticut or Colorado or New Hampshire or Vermont or Arizona or Alabama or Maine or Utah or Mississippi or Montana or South Dakota or Nebraska or New Mexico or Washington or Michigan or Oklahoma
$73k-$120k/yr RemoteFull Time
Active registered nurse (rn) required; experience in appeals & grievances, utilization review, claims processing preferred; familiarity with Utilization Review guidelines and care management systems; strong documentation and case management skills.
Microsoft Word, Microsoft Excel, Macess, CCMS, TruCare, Hyland, InterQual, Milliman
1mo
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Education Manager, Clinical (Grievance & Appeals)
New York, New York, United States
$98k-$131k/yr RemoteFull Time
5+ YOECurrent NY RN license, Master's in Nursing required, 5+ years grievance & appeals experience, clinical education/program design experience, strong communication, presentation, coaching and computer skills.
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Clinical Documentation Specialist - DRG Appeals
Melville, New York, United States
$130k-$170k/yr RemoteFull Time
5+ YOEBachelor of Science in Nursing or NP/PA license, current New York license, CCDS, five years acute hospital experience, two years inpatient CDI, and ICD-10-CM/PCS coding proficiency.
Microsoft Windows, Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Epic, encoder, ICD-10-CM, ICD-10-PCS
1w
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Clinical Documentation Specialist - DRG Appeals
Melville, New York, United States
$130k-$170k/yr OnsiteFull Time
5+ YOEBSN or NP/PA license, current New York license, CCDS, 5 years acute hospital clinical experience, 2 years inpatient CDI experience, and ICD-10-CM/PCS coding proficiency.
Microsoft Windows, Microsoft Office, Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Epic, ICD-10-CM, ICD-10-PCS, AHA Coding Clinics, encoder
2mo
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Care Manager
Bronx, New York, United States
OnsiteFull Time
5+ YOERN with New York license; 3-5 years clinical nursing; 2+ years case management; PRI certification within 1 year; managed care experience; denials/appeals knowledge; bachelor’s degree preferred.
1w
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Clinical Criteria Escalations Specialist
New York City, New York, United States
$95k-$115k/yr HybridFull Time
Active RN or LPN license plus experience in utilization management, prior authorization, medical necessity review, clinical appeals, CDI, payment integrity, or payer policy review. Strong clinical judgment and written communication required.
Medicare, Medicaid, LCDs, NCDs, HCPCS, CPT, ICD-10