- St. Luke's University Health Network (Allentown, PA)
- …communities we serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party ... JOB DUTIES AND RESPONSIBILITIES: + Reviews all Inpatient Retroactive Denials in the Denials Management ...an accredited, professional nursing program. + Must have current RN license to practice in the state of Pennsylvania… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the ... and denials for no authorization. The Senior Denials Management Specialist position communicates...nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- Cognizant (Phoenix, AZ)
- …expectations. **What you need to have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...by performing advanced level work related to clinical denial management and managing clinical denials from Providers… more
- Nuvance Health (Danbury, CT)
- …and trending all appeals and communicating on a daily/regular basis with the Denials Management team. * Assists with informing Managed Care contracting team ... This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to...required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting… more
- University of Michigan (Ann Arbor, MI)
- Clinical Denials Prevention & Appeals Specialist Apply Now **Job Summary** The Clinical Denials Prevention & Appeals Specialist role is entirely remote. ... The Clinical Denials Prevention & Appeals Specialist plays a critical role in optimizing the revenue...outcomes, and training impact, and present regular reports to management . + Illuminate common denial trends and clarify documentation… more
- Catholic Health (Buffalo, NY)
- …finance, business management , operational analysis, information systems or related field + Registered Nurse with a four (4) year degree and Unrestricted NYS ... management and oversight of team Summary: The Clinical Denials and Appeals, Clinical Supervisor is responsible for the...RN license, preferred + Holds, or will obtain within… more
- Community Health Systems (Franklin, TN)
- …+ CRNP, LPN, RN , MD, PA, or DO preferred + CCS-Certified Coding Specialist required or + RHIT - Registered Health Information Technician required or + ... **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits...Medical Coding Program preferred + Associate Degree Health Information Management or related field preferred + 3-5 years Inpatient… more
- Rochester Regional Health (Rochester, NY)
- …BLS - Basic Life Support - American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education Department ... Job Title: Utilization Review Specialist ( RN ) Department: Utilization Management... experience required REQUIRED LICENSURE/CERTIFICATION: + New York State Registered Nurse license. EDUCATION: LICENSES / CERTIFICATIONS:… more
- Trinity Health (Maywood, IL)
- …time management , typing and communication skills are necessary. + Current Registered Nurse License State of Illinois + Specialty certification in clinical ... hybrid, must reside in Illinois. The **Regional Utilization Review Documentation Specialist ** nurse works with the multidisciplinary team including physicians,… more
- HonorHealth (AZ)
- …in an acute care setting. Required1 year experience in UR/UM or Case Management RequiredLicenses and CertificationsRegistered Nurse ( RN ) State And/Or Compact ... it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of health care services… more
- Carle Health (Urbana, IL)
- …assists the team for timely planning and collaboration. Qualifications Certifications: Licensed Registered Professional Nurse ( RN ) - Illinois Department of ... 1 year of nursing experience Responsible for the oversight, coordination, and management of the functional and financial outcomes during acute illness requiring… more
- UPMC (Pittsburgh, PA)
- … Health Information Administrator OR Registered Health Information Technician (RHIT) OR Registered Nurse ( RN ) + Act 34 Current licensure either in ... UPMC Corporate Revenue Cycle is hiring a DRG Specialist II to join our coding team! This... (CCS) OR Certified Professional Coder (CPC) OR Certified Registered Nurse Practitioner OR Doctor of Medicine… more
- HonorHealth (AZ)
- …year experience in UR/UM or Case Management - Required + 3 years as a Registered Nurse in an acute care setting - Required Licenses and Certifications + ... more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of...Registered Nurse ( RN ) State And/Or… more
- Tufts Medicine (Burlington, MA)
- …**Minimum Qualifications for CDI level I:** 1. Associate's degree in Nursing 2. Active Registered Nurse ( RN ) license in Massachusetts or compact state 3. ... (ICU, ED, Critical Care, strong Med/Surg Specialty) OR case management , utilization review, or denials management...level II:** 1. Bachelor's Degree in Nursing 2. Active Registered Nurse ( RN ) license in… more
- Houston Methodist (Houston, TX)
- …includes five years in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure ... At Houston Methodist, the Sr Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse ( RN ) responsible for promoting the… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. ... molecular pathology, high-cost drug, and off-label drug authorizations. The Clinical Authorization Specialist is also responsible for managing denials related to… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Clinical Documentation Integrity Specialist Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the region's ... to be named a Forbes "Best Employer" seven times. Position Summary: The CDI Specialist serves as a liaison between the physicians and hospital departments to promote… more
- Select Medical (West Orange, NJ)
- …14. Performs other duties as requested. **Qualifications** **Minimum Qualifications** + Licensure as a Registered Nurse or LVN/LPN is required + 2 years of of ... A Select Medical Hospital West Orange, NJ **Prior Authorization Specialist / Payor Relations Specialist ( RN...limited to CEO, DBD, CLs, Admissions Coordinator and Case Management team that may help grow relationships and impact… more
- Sanford Health (Sioux Falls, SD)
- …for Nursing Commission for Nursing Education Accreditation (NLN CNEA). Currently holds an unencumbered registered nurse ( RN ) license with the State Board of ... of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to assure compliance… more