- Fort Duncan Regional Medical Center (Eagle Pass, TX)
- …Manage department budget, staffing, and training needs. Function as Utilization Review/ Denials Manager as required. Qualifications Registered Nurse (RN) with ... Position Summary Lead and oversee the hospital's case management department, ensuring patients receive high-quality, efficient, and coordinated care from admission… more
- University Hospitals (Beachwood, OH)
- …*Support for inappropriate level of care and decreased inpatient bed day denials *Continuity and coordination of care *Appropriate and timely authorization for level ... of care *Decreased denials *Appropriate reimbursement Perform timely and accurate review, denial...CM software proficient. (Preferred proficiency) Licenses and Certifications Registered Nurse (RN), Ohio and/or Multi State Compact License (Required… more
- Beth Israel Lahey Health (Plymouth, MA)
- …clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient. Conducts ... with the multidisciplinary team to assess and improve the denial management , documentation, and appeals process. Collaborates with UR Manager and/or physician… more
- Rogers Behavioral Health (Milwaukee, WI)
- …to sites within the scope of AHP licensure. Conduct medication management sessions with patients, Conduct patient medical evaluations and assessments, Conduct ... working relationships with all contracted payors. Review of all denials of service from all payors that are deemed...Be licensed in the state of Wisconsin as a nurse practitioner or physician assistant. Board-eligible AHP. Board certification… more
- NYC Health Hospitals (New York, NY)
- …clarify Diagnoses. Reconcile DRG with the Coders to avoid mismatches daily. Review Denials as assign. SUMMARY OF DUTIES AND RESPONSIBILITIES: 1. Apply knowledge of ... State license and current registration to practice as a Registered Professional Nurse (RN) issued by the New York State Education Department (NYSED); and Bachelor… more
- Jaz Staffing Agency (Houston, TX)
- …information to payors. The role integrates and coordinates resource utilization management , care facilitation and discharge planning functions. In addition, the Case ... position is responsible for coordinating a wide range of self- management support and provides information to update and maintain...Current and valid license to practice as a Registered Nurse in the state of Texas or Current and… more
- Wellstar Health System (Roswell, GA)
- …of illness for a defined patient population. This includes utilization management , transitional care planning, psychosocial and functional status assessment, patient ... knowledgeable and uphold the practice of nursing as outlined by the Georgia Professional Nurse Practice Act and implements the Scope of Practice and Code of Ethics… more
- UofL Health (Louisville, KY)
- … License or compact license with privileges to work in Kentucky Certification: *Case Management Certification (ACM, ANCC- Nurse Case Manager or CCM) preferred ... care. The Utilization Review RN performs activities which support the Utilization Management functions. They are responsible for the delivery of the Utilization … more
- Tucson Medical Center (Tucson, AZ)
- …with concurrent reviews, retrospective reviews including UM Workqueue, chart review, denials management , utilization monitoring, and all other utilization ... to the patient in collaboration with bed control, case management , coding, and billing. The Utilization Nurse ...case management , coding, and billing. The Utilization Nurse Manager is responsible for monitoring listservs and websites… more
- Kaiser Permanente (Baldwin Park, CA)
- …and patient safety, accreditation, regulatory and licensing (AR&L), risk management , and infection prevention and control; evaluating, designing, developing, and ... results. Supports in-depth and advanced quality improvement and improvement risk management efforts by: researching corrective action plan for areas of improvement… more
- Catholic Health Initiatives (Little Rock, AR)
- …as Registered Nurse (RN) 5 years of RN experience **Preferred** Denials management experience Previous case management , utilization management ... an integral role within the revenue cycle by providing clinical expertise in the denials management process. The Denials RN performs a root cause analysis of… more
- Trinity Health (Hartford, CT)
- …expertise as it relates to the preauthorization process + Coordinate denial management processes (ie, Initial Denials such as administrative/technical accounts, ... NAHAM strongly preferred + Knowledge of patient access, revenue cycle and denial management functions; technical and clinical denials areas, such as medical… more
- Children's Mercy Kansas City (Kansas City, MO)
- …lives of children beyond the walls of our hospital. Overview The High-Risk Nurse Lead manages high risk administrative processes and data related to medical ... necessity denials , clinical appeals, long length of stay rounds, and...for the patient population, hospital, care delivery model, care management practices, and payer contracting. Supports facilitation and tracking… more
- Houston Methodist (The Woodlands, TX)
- …manager, denials , and pre-bill team members, as well as management . **PEOPLE ESSENTIAL FUNCTIONS** + Establishes and maintains effective professional working ... At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a licensed registered...determinations (LCDs & NCDs). This position collaborates with case management in the development and implementation of the plan… more
- Children's Mercy Kansas City (Kansas City, MO)
- …beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, evidence-based guidelines, insurance knowledge, ... contracts for medically appropriate level of care. Manages concurrent clinical denials through completion of verbal reconsideration process. Works with physicians… more
- Trinity Health (Ann Arbor, MI)
- **Employment Type:** Full time **Shift:** **Description:** Responsible for coordinating denials with Patient Business Service (PBS) center and ensures compliant and ... complete clinical documentation, assists with denials and related audits, and identifies opportunities for revenue optimization. Investigates denials and root… more
- Crouse Hospital (Syracuse, NY)
- …with Business Office staff regarding workflow processes and maintains an effective denials management process. + General operational oversight includes hiring, ... the RN Care Managers in the department, including Utilization Management , Discharge Planning and Denials and Appeals...Manager, Care Coordination Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree +… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a **Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, Barksdale ... sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states.… more
- UPMC (Pittsburgh, PA)
- …this position is eligible to work from home. The Revenue Cycle Clinical Review Nurse provides support to the local care management departments by initiating the ... retrospective appeal process for acute inpatient clinical denials and audits. The Clinical Review Nurse ...continuum of care. + Assist in determining system-wide care management needs through investigation of retrospective denials … more
- Dignity Health (Carmichael, CA)
- **Responsibilities** **Day Per Diem Utilization Review Registered Nurse - Onsite Campus Position** The **Utilization Review RN** is responsible for the review of ... Concurrent Denial RNs to determine the root cause of denials and implement denial prevention strategies + Collaborates with...experience - OR - a Masters degree in Case Management or Nursing field in lieu of 1 year… more
