Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

Clinical Denials & Appeals Program Lead (RN)

Nahse

Nahse is seeking an experienced professional for a role focusing on appeal management in Los Angeles. The successful candidate will identify educational opportunities to enhance service quality, review denials, and construct detailed appeals based on established guidelines. This position requires a minimum of 4 years of case management experience in an acute care setting and a current California RN license. Knowledge of federal and state regulations is also essential. Favorable consideration will be given to candidates with a Bachelor's degree and certification in case management. #J-18808-Ljbffr Nahse

Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Clinical Denials & Appeals Program Lead (RN) in Los Angeles, CA vacancy
  •  ...Health in California seeks a skilled professional to manage denials and appeals in healthcare. Candidates must have at least 4 years of experience...  ...requires an Associate's degree, a current California RN license, and a preference for those with a Bachelor's degree... 
    Suggested

    340B Health

    Los Angeles, CA
    2 days ago
  • $102.18k

    Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Location: Los Angeles, CA, US, 90017 Position Type: Full...  ...grievances to find the root cause of denials. Check, verify and ensure...  .... As well as motivational programs needed to achieve regulatory... 
    Suggested
    Full time
    Remote work
    Shift work
    Weekend work

    L.A. Care Health Plan

    Los Angeles, CA
    4 days ago
  •  ...providers, and payers to decrease denials and improve quality of service...  .../or community standards. If appeal appropriate, constructs letter of appeal documenting a clinically-oriented rebuttal to denied days...  ...preferred. Current California RN license required. Certified... 
    Suggested

    Nahse

    Los Angeles, CA
    2 days ago
  • $102.18k

    Job Information RN Job Shift: Full Time Pay Range: $102,183...  ..., 90017 Job Description The Lead Appeals and Grievances RN is responsible...  ...Appeals and Grievance (A&G) clinical unit. This position is...  ...1 year of leading a process, program, or staff experience. Preferred... 
    Suggested
    Full time
    Shift work

    Working Nurse

    Los Angeles, CA
    23 hours ago
  • L.A. Care Health Plan in Los Angeles seeks a Lead Customer Solution Center Appeals and Grievances RN to lead a clinical unit responsible for managing appeals and grievances. This role entails reviewing complex clinical cases, ensuring compliance with healthcare regulations... 
    Suggested

    L.A. Care Health Plan

    Los Angeles, CA
    4 days ago
  • $37 - $50 per hour

     ...Clinical Denials Nurse (RN or LVN) Northridge, CA CareNational is looking for an experienced Clinical Denials Nurse (RN or LVN) in Northridge...  .../case management experience Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point)... 
    Hourly pay
    Immediate start
    Work from home

    CareNational

    Los Angeles, CA
    4 days ago
  • Providence is seeking a Clinical Program Manager RN to oversee the operational activities of the structural heart program at Saint John’s Health Center in Santa Monica, CA. This full-time role includes leadership, fostering collaboration, and meeting best clinical practices... 
    Full time

    Providence

    Santa Monica, CA
    2 days ago
  • Molina Healthcare in Los Angeles is seeking a Clinical Training Specialist to create and deliver training programs for clinical staff. This role requires at least 2 years of relevant experience in care or utilization management, alongside training expertise. The ideal... 

    Molina Healthcare

    Los Angeles, CA
    2 days ago
  • Your Role The Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances...  ..., post-service or claim denial. The Appeals and Grievances RN Senior will report to the...  ...skillset utilizing programs such as Microsoft, shared drives... 
    Full time
    Work at office

    Blue Shield of CA

    Los Angeles, CA
    2 days ago
  • A nonprofit organization in California seeks a Clinical Program Supervisor (LMFT or LCSW) for Sherman Oaks. This role involves providing clinical supervision to interns and associates, ensuring compliance with ethical guidelines and professional standards. Candidates should... 

    The Help Group

    Los Angeles, CA
    3 days ago
  • $63.09 - $100.94 per hour

    RN Job RN Clinical Program Manager - Maternal Fetal Treatment Center Shift: 8 Hour Days Pay Range: $63.09 - $100.94 Job ID: 17165 Location: Los Angeles, 90048 Job Description Join us in leading the future of maternal and fetal care! As the Clinical Program Manager... 
    Shift work

    Working Nurse

    Los Angeles, CA
    3 days ago
  • $175k - $210k

    Working Nurse in Los Angeles is hiring a Clinical Nurse Manager (RN) for a full-time position offering a $10,000 sign-on bonus. This role involves...  ...experience, and either possess or be enrolled in a BSN program. The pay range is between $175k - $210k annually, and the... 
    Full time
    Relocation package

    Working Nurse

    Los Angeles, CA
    4 days ago
  • Providence in Santa Monica, CA is seeking a Supervisor of Nursing Clinical Research (RN) to oversee clinical trials and ensure patient well-being. This full-time position involves direct patient interaction, monitoring for adverse reactions, and clear communication about... 
    Full time

    Providence

    Santa Monica, CA
    3 days ago
  • Easter Seals Southern California, Inc. is seeking a Behavior Intervention Supervisor to oversee autism program management. The role involves supervising staff, maintaining program records, and ensuring high-quality intervention services. The ideal candidate will have a... 

    Easter Seals Southern California, Inc.

    Gardena, CA
    2 days ago
  • $56.16 - $75.37 per hour

     ...RN Team Lead Cath Services The power of humankindness works here At CommonSpirit Health...  ...encounters annually through more than 2,300 clinics, care sites and 158 hospital-based...  ...colorectal surgery institute, a gastrointestinal program, and is a Los Angeles County approved... 
    Full time
    Relocation package
    Monday to Friday
    Shift work

    CommonSpirit Health

    Glendale, CA
    3 days ago
  •  ...RN Surgery Team Lead Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit...  ...annually through more than 2,300 clinics, care sites and 158 hospital-based...  ...retirement, wellness, leave, and other programs. CommonSpirit Health is an Equal Opportunity... 

    Common Spirit Health

    Glendale, CA
    11 hours ago
  •  ...Program Lead Horizon Surgical Systems Inc. is revolutionizing the world of surgical ophthalmology by developing a novel, AI driven, and...  ...organizational alignment across R&D, manufacturing, quality, clinical, and regulatory functions, coordinating both waterfall and agile... 
    Remote work
    Relocation

    Horizon Surgical Systems

    Los Angeles, CA
    4 days ago
  • $100k - $125k

     ...of Prior Authorizations (RN or LVN) Northridge,...  ...As the Supervisor of Clinical Denials, you will be responsible for leading and overseeing the clinical...  ...resolution of denials and appeals related to medical...  ...education and training programs for staff to enhance their... 

    CareNational

    Los Angeles, CA
    4 days ago
  • $98.08k

     ...for an experienced Physical Therapist ready to lead, teach, and treat — all in one role. As our Senior PT, Clinic Lead, and Clinical Instructor, you'll shape patient...  ...using the APTA CPI Liaise with affiliate PT program coordinators (ACCEs) on student performance Contribute... 
    Full time
    Relocation package
    Monday to Friday
    Flexible hours
    Shift work

    Gardena Physical Therapy

    Gardena, CA
    5 days ago
  •  ...Lead Transplant Coordinator RN The Lead Transplant Coordinator RN will play a crucial role within our transplant program, assisting the manager in the efficient and effective operations of...  ...transplant patient by: Participate in clinic visits and analyze diagnostic... 
    Full time

    University of Southern California (USC)

    Los Angeles, CA
    4 days ago
  • $100k - $130k

    Remedy Home Health Care in Northridge, CA is hiring a Clinical Supervisor to oversee patient care in a home health setting. The role involves...  ...should have significant Home Health experience, a valid RN license, and a passion for improving patient outcomes. Competitive... 

    Remedy Home Health Care

    Los Angeles, CA
    2 days ago
  • $190k - $230k

     ...build their business through our industry-leading software with powerful tools that...  ...practice management. From admin work to clinical care, our suite of innovative solutions...  ...Best Places to Work. The Role The Program Management and Operations team mission:... 
    Summer work
    Private practice
    Flexible hours

    SimplePractice

    Santa Monica, CA
    1 day ago
  • Blue Shield of CA in Los Angeles is seeking an Appeals and Grievances RN Senior responsible for clinically reviewing member appeals and grievances related to service or claims denials. The ideal candidate will perform timely reviews using established guidelines and ensure... 
    Full time

    Blue Shield of CA

    Los Angeles, CA
    2 days ago
  • $86.4k - $184.8k

    A leading healthcare provider in Los Angeles is seeking an Academic Program Management Officer 3 to oversee fiscal operations and enhance program performance for the Family...  ...from $86,400 to $184,800 and may convert to a career role. #J-18808-Ljbffr UCLA Outpatient Clinics
    Contract work

    UCLA Outpatient Clinics

    Los Angeles, CA
    2 days ago
  • 340B Health is seeking a Specialty Pharmacist Program Coordinator at Cedars-Sinai Medical Center in Los Angeles, CA. The role involves...  ...skills and knowledge of drug usage. This position emphasizes both clinical and operational decision-making within the specialty pharmacy.... 

    340B Health

    Beverly Hills, CA
    4 days ago
  • A leading healthcare institution is seeking a Clinical Program Manager for Quality (BMT/CAR T) to enhance patient care and drive operational efficiency. Responsibilities include developing quality programs, overseeing multidisciplinary teams, and leading continuous quality... 

    Cedars-Sinai Medical Center

    Beverly Hills, CA
    1 day ago
  • $95.4k - $208.3k

     ...Angeles to drive quality improvement efforts in healthcare. The ideal candidate will collaborate with clinical and operational teams to manage the Quality Incentive Pool Program (QIP), ensuring efficiency and effectiveness across the UCLA Health system. Qualifications... 

    Nahse

    Los Angeles, CA
    23 hours ago
  • A community-focused health organization in Los Angeles seeks a dedicated individual for a new Substance Use Disorder program. This role involves shaping the program, impacting clients directly, and building a passionate team. Candidates should possess a Master’s degree... 

    Ami Network

    Los Angeles, CA
    3 days ago
  • $80k - $90k

    A child-focused therapy organization in Alhambra is seeking a dedicated Program Director to oversee ABA program implementation and lead a clinical team. The ideal candidate will possess a Master’s or Ph.D., BCBA credential, and a minimum of one year of relevant experience... 

    FirstSteps for Kids, Inc.

    Alhambra, CA
    3 days ago
  •  ...Summary: Functions as a Lead of the healthcare team,...  ...professional practice. Has appropriate clinical skills to be an expert...  ...professional nursing practice (e.g. RN/MD Collaborating for Outcomes,...  ...) activities and educational programs). Demonstrates knowledge of patients... 
    Full time
    Work at office

    Kaiser Permanente

    Inglewood, CA
    -4

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Clinical Denials & Appeals Program Lead (RN). Be the first to apply!