- AdventHealth (Orlando, FL)
- …'s of Nursing [Required] + 2 medical/hospital nursing experience [Required] + Registered Nurse ( RN ) [Required] **Preferred qualifications:** + Prior ... ROLLINS STREET, Orlando, 32803 **The role you'll contribute:** The RN Care Manager in collaboration with the...who no longer meet medical necessity and escalates potential denials , documents avoidable days, and facilitates progression of care.… more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of the ... appeals as required by the third-party payers to overturn denials and increase reimbursement. Responds to customer service issues...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Stony Brook University (Stony Brook, NY)
- RN Case Manager **Position Summary** At Stony Brook Medicine, a **TH Staff Associate /Case Manager ** is a valuable member of our team, who provides ... high standard of excellence. **Duties of a TH Staff Associate /Case Manager in the Care Management Department...other duties as required. **Qualifications** **Required** : Current NYS RN . A Bachelor's degree or a nurse … more
- Baylor Scott & White Health (Dallas, TX)
- **JOB SUMMARY** The Utilization Review Registered Nurse ( RN ) provides a clinical review of cases using medical necessity criteria to determine the medical ... email. Certified Case Manager (CCM), Accredited Case Manager (ACM), or Certified Managed Care Nurse ...- 3 Years of Experience - CERTIFICATION/LICENSE/REGISTRATION - & Registered Nurse ( RN ) As a… more
- BronxCare Health System (Bronx, NY)
- …the department physician advisors and clinical staff. Qualifications - NYS Registered Nurse required - The Appeal Manager must have excellent verbal and ... on identified deficiencies to best respond to all hospital denials notification and documentation efforts. The Appeals Manager...data entry into an electronic database system. -The Appeal Manager should be a nurse who has… more
- UNC Health Care (Rocky Mount, NC)
- …in accordance with utilization review guidelines. Tactfully and effectively informs Manager of physicians' impact days and constructively offers more cost-effective ... 3. Determines frequency of patient reassessments according to identified needs and input from RN and MD. Serves as a resource person for nursing staff related to… more
- Nuvance Health (Poughkeepsie, NY)
- …the ER and Observation units Under the general supervision of the Director, The Nurse Case Manager role provide clinically-based case management to support the ... have Associate 's Degree or BSN preferred. Must have current RN license. Preferred experience in Utilization Review/Management. Location: Vassar Brothers Medical… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... policies. This role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate… more
- Ascension Health (Austin, TX)
- …and gynecology) + **Practice Detail:** Ambulatory Clinic Support: Medical Assistant, Registered Nurse , Social Worker, Dietician, Psychology + **EMR System:** ... consisting of: Nurse Practitioner specializing in eating disorders, Psychologists, Nurse Manager , RNs, Medical Assistants, Social Workers, and collaboration… more
- University of Southern California (Arcadia, CA)
- …coding appeals based on documentation, coding guidelines and Coding Clinic for coding denials and/or adjustments. + Extensive knowledge of Medicare Part A and how ... impact DRG assignments. + Minimum of three years' experience in clinical disciplines ( RN , MD, FMG) or utilization review/case management in an acute care facility,… more
- UnityPoint Health (Des Moines, IA)
- …clinical needs, barriers to quality care, effective utilization of resources and pursues denials of payment and referrals in a timely, legible manner. + Tighter ... report. + Ensure verbal communication with the ambulatory / cross continuum care manager regarding patients who have moderate or red vulnerability at transition. +… more