Clinical Review Nurse - UM & Post-Appeals (RN)
$29.05 - $67.97 per hourMolina Healthcare of Illinois
Molina Healthcare in Scottsdale, Arizona is seeking a clinical nurse to oversee the medical review process, ensuring claims and records meet necessary guidelines. The successful candidate will facilitate medical reviews, validate reimbursement claims, and support clinical decision-making based on expert judgment. Applicants must possess an active RN license and have experience in clinical nursing and utilization review. Additionally, familiarity with coding and regulatory standards is essential. The role offers a competitive pay range of $29.05 - $67.97 per hour, based on experience and location. #J-18808-Ljbffr Molina Healthcare
$29.05 - $67.97 per hour
...Summary Utilizing clinical knowledge and experience... ..., responsible for review of documentation... ...review of appeals for denied prior authorizations... ...2 years clinical nursing experience,... ...Registered Nurse (RN). License must be... ...compensation may vary from posting based on...SuggestedHourly payWork experience placementWork at office$29.05 - $67.97 per hour
...Summary Utilizing clinical knowledge and... ..., responsible for review of documentation to... ...concurrent review of appeals for denied prior authorizations... ...2 years clinical nursing experience,... ...Registered Nurse (RN). License must be... ...may vary from posting based on geographic...SuggestedHourly payWork experience placementWork at office- ...As a Registered Nurse with us, you'll... ...and utilization review. The position serves... ...training for RN Case Managers.... ...the appropriate post hospitalization... ...their Medicare appeal rights and initiates... ...access and interpret clinical information... ...Midas or on the UM Worksheet...Suggested16 hoursWork at officeFlexible hours
$26.41 - $51.49 per hour
Molina Healthcare is seeking an RN with at least 2 years of experience in hospital acute care for a remote role supporting the Arizona... ...include assessing inpatient services, analyzing clinical requests, and collaborating with healthcare teams to ensure optimal...SuggestedHourly payRemote work$26.41 - $51.49 per hour
...candidate with an Arizona RN licensure. The... ...experience with UM and prior authorization... .... + Analyzes clinical service requests from... ...Conducts inpatient reviews to determine financial... .... - Registered Nurse (RN). License must... ...compensation may vary from posting based on geographic...SuggestedHourly payWork experience placementWork at officeRemote workMonday to FridayWeekend work$60.2k - $107.4k
...Growing together. The Senior Clinical Administrative Nurse is an outreach‑intensive... ...including support through the appeals process Educate members on... ...: Current and unrestricted RN compact license Ability to... ...Application Deadline : This will be posted for a minimum of 2 business...Minimum wageFull timeWork experience placementLocal areaRemote workWeekday work$2,231 - $2,410 per week
...Registered Nurse (RN) | Cardiac Catheterization Lab Location: Phoenix, AZ Agency:... ...Nursing Satisfaction by MIT Sloan Management Review. No matter if you want to explore the... ...after 6 months · 24/7 support · Clinical support throughout your assignment 298...Full timeContract workLocal areaImmediate startShift work- ...Registered Nurse (RN) | Interventional Radiology Location: Phoenix... ...the support of a dedicated clinical team. Required Qualifications... ...sedation administration, and post-procedure recovery management... ...assessments, including reviewing medical history and lab results...Weekly payFull timeContract workTemporary workShift work
- ...Registered Nurse (RN) | Interventional Radiology Location: Phoenix... ...the support of a dedicated clinical team. Required Qualifications... ...sedation administration, and post-procedure recovery management... ...assessments, including reviewing medical history and lab results...Weekly payFull timeContract workTemporary workShift work
$2,279 - $2,458 per week
...Registered Nurse (RN) | Pediatric Intensive Care Unit Location: Phoenix, AZ Agency... ...Nursing Satisfaction by MIT Sloan Management Review. No matter if you want to explore the... ...after 6 months · 24/7 support · Clinical support throughout your assignment 282...Full timeLocal areaImmediate startShift work$2,168 per week
...Registered Nurse (RN) | Pediatric Intensive Care Unit Location: Phoenix, AZ Agency: Atlas MedStaff Pay: $2,168 per week... ...Great Recruiters. Both of those recognitions are fueled by real reviews by real travel nurses and allied healthcare professionals that...Hourly payFull timeContract workWork at officeRemote workShift workNight shiftWeekend work$50 per hour
...We are looking for a Clinical Appeals Nurse to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model. In this role, you will need to be an expert in healthcare...Hourly payFull timePart timeFor contractorsRemote workFlexible hours$2,428 per week
...Registered Nurse (RN) | Cardiovascular Operating Room Location: Phoenix, AZ Agency: Mindlance Health Pay: $2,428 per week... ...REQUIRES STRICT ADHERENCE TO ALL BACKGROUNDCHECK STANDARDS. PLEASE REVIEW THE COMPLIANCE REQUIREMENTS AS SOON AS POSSIBLE.PROFILE...Full timeContract workImmediate startAll shiftsFlexible hoursShift work$2,428 per week
...Registered Nurse (RN) | Cardiovascular Operating Room Location: Phoenix, AZ Agency: Mindlance Health Pay: $2,428 per week... ...REQUIRES STRICT ADHERENCE TO ALL BACKGROUNDCHECK STANDARDS. PLEASE REVIEW THE COMPLIANCE REQUIREMENTS AS SOON AS POSSIBLE.PROFILE...Full timeContract workImmediate startAll shiftsFlexible hoursShift work- ...Job Role: Nurse Abstractor Remote 99% (occasional in-person attendance required... ...Program Overview The Suicide Mortality Review (SMR) Program, within the Arizona... ...Qualifications • Education: Registered Nurse Clinical Licensure (RN, LPC, APRN) Bachelor's Degree in...Part timeWork at officeRemote workFlexible hoursAfternoon shift
$2,268 per week
...Registered Nurse (RN) | Cardiovascular Operating Room Location: Phoenix, AZ Agency... ...Assess patients prior to surgery by reviewing medical histories, allergies, and current... ...the patient for signs of complications post-surgery, such as bleeding, infection, or...Full timeContract workImmediate startShift work$73k - $75k
...Workplaces in Financial Services & Insurance RN Utilization Review PRIMARY PURPOSE: To provide timely,... ...claim examiners as needed to provide clinical information to resolve issues.... ...jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by...Work at officeFlexible hours$25 per hour
...Nurse Supervisor RN Join the compassionate care team at The Terraces of Phoenix, a premier HumanGood... ...in related field Excellent clinical observation and assessment skills Proficient... ...necessary to complete documentation, review electronic health records and...Full timeMonday to FridayNight shiftWeekend work$25 per hour
...currently seeking a Full-time Night Shift Nurse Supervisor RN to join our Skilled Nursing team and... ...experience in related field Excellent clinical observation and assessment skills... ...skills necessary to complete documentation, review electronic health records and...Full timeMonday to FridayNight shiftWeekend work- ...implements, evaluates and documents nursing care of patients in accordance... ...and discharge planning needs. Reviews patient history and physical... ...in research activities within clinical practice. Participates in... ...Must possess a current, valid RN license in state of practice,...Temporary workImmediate start
- ...Overview We are seeking a dynamic and compassionate Director of Nursing (RN) to lead our hospice care team with energy and dedication.... .... Oversee the management of medical records, documentation review, and electronic health record (EHR) systems to ensure accuracy...Shift work
- ...Emergency Department Registered Nurse This position will work in collaboration with... ...member of the care team Excellence in clinical care, service and communication Collaborative... ...competency. Provides timely feedback and review of care delivery to ensure maintenance of...
- ...implements, evaluates and documents nursing care of patients in accordance... ...and discharge planning needs. Reviews patient history and physical... ...in research activities within clinical practice. Participates in... ...Must possess a current, valid RN license in state of practice,...Full timeTemporary workImmediate startRelocation package
$85k - $92k
...supporting a large-scale federal healthcare program to identify a Clinical Quality Reviewer. This role focuses on reviewing clinical cases,... ...you must have Active, unrestricted license as a Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) Minimum 3+ years...Remote jobHourly payWork at officeHome office- ...please inquire! A Home Therapy nurse trains home hemo or peritoneal... .... We lead the industry in clinical quality improvement,... ...procedures. Communicate and regularly review Emergency Preparedness procedures... ...include: ~ Current RN license in applicable state. License...Full timePart timeLocal areaRelocation packageMonday to FridayFlexible hoursNight shiftWeekend work
$85k - $92k
...HAVE) Active, unrestricted license: RN Minimum 3+ years clinical experience (med/surg and/or behavioral... ...DESIRED) Clinical Quality / Utilization Review / Case Review experience Experience... ...exposure Bachelor’s degree in Nursing or healthcare-related field CORE RESPONSIBILITIES...Hourly payRemote workDay shift- Grand Canyon University has an opening for Adjunct Clinical Nursing faculty members, and we invite applications from individuals who are enthusiastic... ...An active, current, unencumbered, and multi-state (compact) RN license Must successfully pass a drug test and competency...Work experience placementReliefImmediate start
- ...Clinical Coordinator DaVita is hiring a Clinical Coordinator to lead outpatient dialysis care for patients with end-stage renal disease... ..., team-oriented environment Requirements: ~ Current RN license and CPR certification ~18+ months RN experience, including...Flexible hours
$2,064 per week
...Registered Nurse (RN) | Orthopedics Location: Phoenix, AZ Agency: AHS Staffing Pay: $2,064 per week Shift Information: Nights - 5 days x 8 hours Contract Duration: 14 Weeks Start Date: 6/22/2026 About the Position AHS Staffing is looking...Full timeContract workShift workNight shift$1,971 per week
...Registered Nurse (RN) | Orthopedics Location: Phoenix, AZ Agency: AHS Staffing Pay: $1,971 per week Shift Information: Nights - 5 days x 8 hours Contract Duration: 14 Weeks Start Date: 6/15/2026 About the Position TravelNurseSource is...Permanent employmentFull timeContract workTemporary workShift workNight shift
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Clinical Review Nurse - UM & Post-Appeals (RN). Be the first to apply!
- primary care nurse practitioner Scottsdale, AZ
- nurse practitioner geriatrics Scottsdale, AZ
- clinical resource nurse Scottsdale, AZ
- hospice nurse practitioner Scottsdale, AZ
- telemedicine nurse practitioner Scottsdale, AZ
- remote nurse case manager Scottsdale, AZ
- advanced practice nurse Scottsdale, AZ
- bilingual nurse practitioner Scottsdale, AZ
- nurse practitioner - telehealth Scottsdale, AZ
- nurse practitioner - medicare assessments Scottsdale, AZ



