Clinical Appeals Nurse: Medical Reviews & State Hearings
CareSource
A healthcare organization is seeking a Clinical Appeals Nurse in Indianapolis, IN. This role involves processing clinical appeals and participating in state hearings. Essential functions include analyzing medical records and effectively communicating outcomes. Candidates must have a current RN license and preferably an Associate's Degree, along with experience in managed care and clinical appeals. The position offers a competitive salary ranging from $62,700.00 to $100,400.00, with an hourly compensation type and opportunities for bonuses based on performance. #J-18808-Ljbffr CareSource
- ...2026-06-05 Position Title: Clinical Review Nurse I (US) Job Description: Clinical... ...responsible for reviewing and making medical determinations as to whether a claim meets... ...requirement of living in the United States at least three of the past five years....MedicalFull timeTemporary workWork at officeLocal areaMonday to FridayFlexible hoursDay shift1 day per week
- ...Clinical Review Nurse I (US) Clinical Review Nurse I - Medicare Part A Location: This role enables... ...responsible for reviewing and making medical determinations as to whether a claim... ...requirement of living in the United States at least three of the past five years....MedicalFull timeWork at officeMonday to FridayFlexible hoursDay shift
$109.5k - $164k
...requires travel across the entire state of Indiana, approximately 85... ...Practice Clinician (Nurse Practitioner or Physician Assistant... ..., including: Past medical history review, medication reconciliation,... ...Qualifications: ~1+ years of clinical experience (family, geriatric...MedicalMinimum wageWork experience placementLocal areaRelocation packageFlexible hours- ...Clinical Appeals Reviewer (Licensed Healthcare Professional) Fully Remote-United States Job Type Full-time Description Overview... ...not limited to Registered Nurses (RN), Physical Therapists (... ...Responsibilities Reviews medical records/case files, writes...MedicalFull timeContract workPart timeFor contractorsWork at officeLocal areaRemote workNight shift
$78.4k - $107.8k
...community Job Summary Clinical Competency, Remediation... ...Competency & Quality Nurse is a Center of... ...in partnership with the Medical Director, Care Integration... ...practices; perform targeted reviews of charts and recorded... ...work from Home in the state of California, Illinois...MedicalBi-weekly payFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome officeMonday to Friday- ...RN Days, Richmond State Hospital... ...Description: Staff Nurse, 12.5 hour days; 0... ...patient care and clinical supervision of support... ...plans, and maintain medical records. A Day... ...supervision and work is reviewed for general... ...observational and hearing skills to stay alert...MedicalContract workLocal areaImmediate startShift workWeekend workAfternoon shift
- ...Corp / 1099 / Contract W2 Client: State of Indiana Interview Type:... ...MSN, MPH, or MS. Minimum of three years clinical and infection control experience in a healthcare... ...to provide technical assistance to medical practitioners, LTC and AL staff, public health...MedicalContract workWork at officeLocal areaNight shift
- ...Nursing Team Opportunities At IU Health Indiana University... ...collaborate with top medical professionals. At IU... ...where you can develop clinical expertise explore... ...Registered Nurse license in the state of Indiana or an active... ...are subject to review and approval by the Chief...MedicalLocal area
- ...professionals in clinical and non-clinical positions... ...Order Pharmacies, Medical Billing Centers,... ...the United States. HealthCare Support... .... May also manage appeals for services denied... ...treatment setting reviews to ensure compliance... ...of IN AS/BS in Nursing or combination of...MedicalPrivate practiceImmediate start
$90.87 - $154.33 per hour
...pharmacy with us. Physician Clinical Reviewer-Oncologist- REMOTE Job... ..., and provides timely medical review of service... ...and expedited appeals. Provides assistance and... ...cases and/or attends hearings for discussion of utilization... ...to work in the United States without the need for...MedicalWork at officeLocal areaRemote workVisa sponsorshipWork visa- ...surgery at the RLR VA Medical Center. Provide... ...patient care. Clinical Practice - Surgical... ...effective use of the nursing process to make... ...driver's licenses or state-issued... ...involving in-depth review and analysis of medical... .../40 in the other, hearing (aid permitted), emotional...MedicalFull timeTemporary workPart timeSeasonal workWork at officeImmediate startRemote workTrial periodRelocation packageMonday to Friday
- ...direction of the Practice Medical Director and... ...FUNCTIONS: Clinical Quality & Competence... ...audits, peer review, patient satisfaction... ...appropriate clinician/nursing staff for call or... ...environment; see, hear, talk, walk, sit... ...required by the state. ACKNOWLEDGMENT...MedicalWork at office
$105.5k - $168.4k
...About Us Matrix Medical Network pioneered the first national in-home clinical network, and today we’re... ...hour, Matrix providers review and observe a member’s... ...their homes or Skilled Nursing Facilities Benefits of... ...in obtaining additional state licensure and credentialing...MedicalFull timeWork at officeLocal areaRelocation packageMonday to FridayNight shift- ...POSITION SUMMARY: The Medical Assistant serves as support... ...of a registered nurse; collaborates with medical... ...standards of care set by state board of licensure and... ..., Lifting, Talking, Hearing. • Physical requirements... ...information, please review the Know Your Rights notice...MedicalHourly payFull timeReliefShift workWeekend work
- ...assists with coordinating nursing service activities with... ...as well as Federal and State regulations governing... ...with professional medical persons and has willingness... ...practice. Assist with reviewing personnel complaints and... ...colors, ability to hear and respond to pages....Medical
$38.7 - $43 per hour
...hour Department (Org): Clinic You Matter • Make a difference... ...benefits including medical, dental, vision, paid... ...The Clinical Nurse Educator is responsible... ...local nursing schools and reviewing and revising policies as... ...Registered Nurse (RN) in the state of practice. Must be...MedicalLocal area- ...remote position. Registered Nurse Clinical Auditor We are seeking a... ...Registered Nurse to support medical record reviews, billing compliance audits... ...and reports, and supporting appeals activities. This is a remote... ...all work aligns with state, federal, and national healthcare...MedicalContract workRemote work
$62.7k - $100.4k
Job Summary The Clinical Appeals Nurse is responsible for processing clinical appeals and attending state hearings within compliance and regulatory standards,... ...all states Perform clinical reviews of member and provider appeals for medical, dental, behavioral health, pharmacy...MedicalHourly payWork at officeWeekend workAfternoon shift$67.31k
...fulfilling career with the State of Indiana by joining... .... Role Overview The Appeals Referee is an Administrative... ...unemployment insurance hearings in accordance with... ...follows: Receive and review case files prior to scheduling... ...includes: Three (3) medical plan options (including...MedicalFull timeWork experience placementRelocation- ...Bloomington, Indiana is seeking an Appeals Referee (Administrative Law... ...unemployment insurance hearings. This role requires a Juris Doctorate... ...and admission to the Indiana State Bar. Responsibilities include... ...is offered, including medical options and paid leave. Join...Medical
- ...Appeals Pharmacist – Ensure Fair Medication Access for Patients A confidential managed... ...Pharmacist to review, evaluate, and process... ...to leverage their clinical knowledge and... ...Collaborate with physicians, nurses, and medical... ...in compliance with state and federal regulations...MedicalRemote work
- ...Nurse Practitioner Location/Department: Hospital... ...eligible Job Summary: A clinically competent NP who... ...and the management of medical conditions both acute and... ...Participates in quality assurance reviews Utilize community... ...as an APN in the state of Indiana Minimum of...MedicalPart timeWork experience placementWork at office
$1,954 - $2,107 per week
...Registered Nurse (RN) | Case Manager Location:... ...travelers. Day one medical, dental and vision insurance... ...MIT Sloan Management Review. No matter if you want... ...of jobs in all 50 states. This means you get priority... ...· 24/7 support · Clinical support throughout your...MedicalFull timeLocal areaImmediate start$107.82k - $145.88k
...impact in this role Lead clinical incident investigations... ...performance concerns, medication errors, and sentinel... ...facility leadership. Review and validate candidate... ...accepted. Registered Nurse obtained prior to hire... ...with applicable federal, state and local laws. For further...MedicalFull timeTemporary workLocal areaRemote workDay shift- ...Nurse Practitioner Opportunity Attention all Nurse... ...Program (RHRP) in the State of _________ on an "as... ...readiness services to meet the medical and dental requirements... ...military personnel. Review health history, service... ...through our fixed-clinic, mobile treatment...MedicalFor contractorsLocal areaRemote workWeekend workWeekday work
- ...Clinical Nurse Resident (RN) - New & Upcoming Grads Part-time and full-time outpatient and... ...join our team and collaborate with top medical professionals. New registered nurse (... ...active Registered Nurse (RN) license in the state of Indiana or an active Nurse Licensure...MedicalFull timePart timeWork experience placementLocal areaRelocation package
$123.8k - $170.3k
...5 centers across eight states under two brands: CenterWell... ...everything we do. Our Clinics offer a team-based care... ...The Nurse Practitioner (NP) works... ...care. Follow level of medical care and quality for patients... ...available data and chart reviews. Help coordinate patient...MedicalTemporary workLocal area$91.7k - $163.7k
...requires travel across the entire states of Ohio, West Virginia,... ...Practice Clinician (Nurse Practitioner or Physician Assistant... ...assessments, including: Past medical history review, medication reconciliation,... ...: ~1+ years of clinical experience (family, geriatric...MedicalMinimum wageFull timeWork experience placementLocal areaRelocation packageFlexible hours- ...Director Of Nursing (Don) Skilled Nursing At The Stratford... ...fit—someone who brings clinical wisdom, steady... ...department. Must have a current state licensure as a RN in... ...their physicians, the Medical Director, the Executive... ...and annual policy reviews. Assumes the responsibilities...MedicalWork at officeWeekend work
$123.8k - $170.3k
...5 centers across eight states under two brands: CenterWell... ...everything we do. Our Clinics offer a team-based care... ...: The Nurse Practitioner (NP) works... ...care. Follow level of medical care and quality for patients... ...available data and chart reviews. Help coordinate patient...MedicalFull timeTemporary workApprenticeshipLocal area
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