- Monster (Allentown, PA)
- …appeals , case resolution, and impact on revenue and trending. Coordinates RAC appeals for complex case reviews for medical necessity, including determining if ... Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks outcomes regarding appeal process. Assists billing staff… more
- Emanate Health (Covina, CA)
- …States, and the #19 ranked company in the country. **J** **ob Summary** The Manager, Medical Necessity Review & Appeals is responsible for overseeing the ... years in Case Management, Utilization Review , payer appeals or related programs required. Experience with medical...payers, and internal departments. **Minimum License Requirement :** California RN or LVN license. RN license is… more
- Centene Corporation (Sacramento, CA)
- …exp preferred** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- Centene Corporation (Columbia, SC)
- …State and NCQA requirements. + Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of ... **Position Purpose:** Act as the liaison for all statewide appeals , fair hearings, review organizations, and other...NCQA standards. + Maintain files and logs for all appeals + Coordinate with Medical Director(s) to… more
- CVS Health (Hartford, CT)
- …The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare Part C appeals from both members and providers. ... a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,...communication skills. + Strong organizational skills **Preferred Qualifications** + Appeals Experience + Utilization Review + Medicare… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse ( RN ) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances ... presentations. Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and… more
- Nuvance Health (Danbury, CT)
- …in nursing, health administration, or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience ... leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical...medical necessity outreach, and feedback to the utilization review team on denial outcomes. * *Discharge Planning &… more
- Molina Healthcare (Warren, MI)
- …will work on set schedule) Looking for a RN with experience with appeals , claims review , and medical coding. **Job Summary** Utilizing clinical knowledge ... and experience, responsible for review of documentation to ensure medical necessity...state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- CVS Health (Albany, NY)
- …strong diverse Utilization Review experience, ie Utilization Management, Precertification, + Registered Nurse that must hold an unrestricted license in their ... to a claim. This could include intake, UM, precertification, clinical claim review , appeals . Responsible for providing analysis, presentation, and other support… more
- State of Colorado (Denver, CO)
- …(HP III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5058918) Apply Registered Nurse Complaints Health Compliance Inspector - ... Registered Nurse Complaints Health Compliance Inspector -...FAA00731 (HP III RN ) Salary $80,916.00 - $90,648.00 Annually Location Denver, CO Job… more
- Beth Israel Lahey Health (Boston, MA)
- …other related duties as required and directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse ( RN ), Massachusetts + Three years of recent ... Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate...Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical… more
- State of Colorado (Denver, CO)
- …III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5075443) Apply Registered Nurse Health Compliance Inspector, Nursing ... Registered Nurse Health Compliance Inspector, Nursing...Facilities - FAA00867 (HP III RN ) Salary $80,916.00 Annually Location Denver, CO Job Type… more
- Mount Sinai Health System (Long Island City, NY)
- …field. **Licensing and Certification Requirements (if applicable)** Licensed as a registered nurse , Issuing Agency: Department of Health/Office of Professions ... The Director will direct and manage departmental activities involved in utilization review , appeals management and discharge planning to facilitate the case… more
- State of Colorado (Golden, CO)
- Registered Nurse I, RN I - Campus at Lookout Mountain, Youth Services Center - Golden Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5008113) Apply Registered Nurse I, RN I...practice. Obtains laboratory and other diagnostic procedures ordered by medical providers, review results and notify provider… more
- St. Luke's University Health Network (Allentown, PA)
- …near vision, visual monotony. EDUCATION: Graduate of an accredited professional nursing program. Registered nurse with current license to practice in the state ... experimental, coding or other issues that may require record review . Provides billing with information needed to obtain payment...and impact on revenue and trending. + Coordinates RAC appeals for complex case reviews for medical … more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive experience in utilization ... flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as...as indicated through research and coordination of completion of medical records and utilization review processes. Identifies… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4963973) Apply CDOC Registered Nurse ( Nurse ... and staff instruction; + Assists physicians, physician assistants, and nurse practitioners with minor medical and surgical...Applicant must possess a current, valid license as a Registered Nurse from the Colorado Board of… more
- Molina Healthcare (Omaha, NE)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of previously ... + Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training,… more
- Sacramento County (Sacramento, CA)
- …read and understood the above instructions. 02 Select the one box that best describes your Registered Nurse ( RN ) license issued by the State of California. + ... Registered Nurse D/CF (Level I/II) Print...interviewing patients and assisting them in follow-up care; maintaining medical and medication supplies; rendering emergency medical … more
- Sacramento County (Sacramento, CA)
- Supervising Registered Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448883) Apply Supervising Registered Nurse ... are at 5:00 pm on: 2/3/25, 4/7/25, 6/2/25, 8/4/25, 10/6/25, 12/1/25 Supervising Registered Nurse - Detention/Correctional Facility is the first level supervisory… more
