Clinical Appeals Nurse
CareSource
About this role
The Clinical Appeals Nurse adjudicates clinical appeals and participates in state hearings to ensure decisions comply with regulatory, contractual, and clinical standards. The role operates within the health plan’s clinical governance framework and partners with medical leadership and internal teams to manage complex case review and external review processes.
Skills
Qualifications
About CareSource
caresource.comCareSource is a nonprofit managed care organization that provides health insurance plans and related healthcare services, primarily through Medicaid, Medicare, and Marketplace offerings. The company works with members, providers, and government partners to deliver access to medical, behavioral health, and care management services in the health insurance industry.
Recent company news
Modern HealthcareDeals tracker: Elsevier to acquire Mytonomy
1 day ago
WPRInsurance provider will stop offering Affordable Care Act coverage in 11 Wisconsin counties
Sep 19, 2025
Hospice NewsCareSource Sees Reduced Hospitalizations Via Tuesday Health Partnership
Oct 14, 2025
Dayton Daily NewsCareSource and other local companies are up for state tax credits
Dec 11, 2025
Captive InternationalAM Best posts A- ratings for CareSource Re
1 month ago
About CareSource
Headquarters
San Francisco, CA
Company Size
201-500 employees
Founded
2018
Industry
Technology
Glassdoor Rating
4.2 / 5
Leadership Team
Sarah Johnson
Chief Executive Officer
Michael Chen
Chief Technology Officer
Emily Williams
VP of Engineering
David Rodriguez
VP of Product
Jessica Thompson
Chief Financial Officer
Andrew Park
VP of Sales
Unlock Company Insights
View leadership team, funding history,
and employee contacts for CareSource.
Salary
$63k – $100k
per year
More jobs at CareSource
Similar Jobs
Clinical Appeals Nurse
Blue Cross of Idaho
Clinical Appeal and Grievance Nurse
Brigham and Women's Hospital
Appeals and Grievances Clinical Specialist
Healthfirst
Appeals and Grievances Clinical Specialist
Healthfirst
Appeals Clinician (Monday - Friday)
PacificSource Health Plans
Nurse Appeals Associate
Elevance Health