- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse ( RN ) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & ... + Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and… more
- Actalent (Sacramento, CA)
- Job Title: Appeals and Grievances Registered Nurse Job Description We are seeking a skilled professional to join our team and handle member appeals and ... and post-service concerns, reviewing medical records and documentation to evaluate appeals , conducting timely and accurate first-level clinical reviews using… more
- McLaren Health Care (Grand Blanc, MI)
- …related duties as required and directed. **Qualifications:** _Required_ + State licensure as a registered nurse ( RN ) + Bachelor's degree in nursing from ... and commercial insurance. 8. Educates health team colleagues about complex clinical appeals , utilization review, including role, responsibilities tools, and… 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 - Campus at Lookout Mountain, Youth Services Center… more
- Walgreens (Deerfield, IL)
- …for customers, patients, team members and communities. **Job ID:** 1655228BR **Title:** Registered Nurse ( RN ) Specialty **Company Indicator:** Walgreens ... **External Basic Qualifications:** + Associate's degree in Nursing + Current license/registration as an RN ( Registered Nurse ) with the State Board of Nursing… more
- Beth Israel Lahey Health (Boston, MA)
- …directed. **Qualifications:** _Required_ + Licensure as a Registered Nurse ( RN ), Massachusetts + Three years of recent clinical or utilization management ... Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on the… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print...RN license. 07 Do you possess an active RN license issued by an Enhanced Nurse Licensure ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4963973) Apply CDOC Registered Nurse ( Nurse I) Salary $7,591.00 - $10,627.00 Monthly… 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...+ Use and care of medical equipment used in clinical and infirmary settings + Basic medical indications of… more
- State of Colorado (Pueblo, CO)
- Nurse I - Registered Nurse...This position is responsible for assisting nursing staff with clinical direction of nursing staff, QA/PI activities and to ... - CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5101894) Apply Nurse I - Registered Nurse I - CMHHIP Salary $43.80 - $61.31… more
- State of Colorado (Denver, CO)
- Registered Nurse I-Colorado Mental Health Hospital in Fort Logan-Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5078182) Apply ... Registered Nurse I-Colorado Mental Health Hospital in...During specific shifts, functions in the role of Charge Nurse and provides clinical and administrative supervision… more
- Commonwealth Care Alliance (Boston, MA)
- …complexities that require intensive care management and care delivery. Within the CIC Program, the Registered Nurse ( RN ) serves as an integral member of an ... and addresses significant medical, behavioral, and social needs. The RN uses evidenced-based care approaches, clinical skills,...including: + 5+ years' experience as Registered Nurse in a high touch clinical environment… more
- State of Colorado (Pueblo, CO)
- Registered Nurse II- CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5101960) Apply Registered Nurse II- CMHHIP Salary ... closing date and time listed. + Description + Benefits + Questions Department Information Registered Nurse II-Full Time CMHHIP This posting will be used to fill… more
- Intermountain Health (Billings, MT)
- **Job Description:** The Registered Nurse ( RN ) is a professional caregiver who assumes responsibility and accountability for assessing, planning, ... coordination of care with other health team members. The Registered Nurse ( RN ) is a...Billings has a one-of-a-kind lifestyle with work balance that appeals to many. Check out these videos to hear… 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, ... (e) and (o). After following the directed methodology for appeals , the MTF will also adhere to its respective...Utilization Management is required. Full time employment as a registered nurse within the last 36 months… more
- CommonSpirit Health Mountain Region (Westminster, CO)
- …will cultivate excellence and achieve professional fulfillment united in humankindness. As a Registered Nurse ( RN ) you will assume responsibility and ... external applicants with at least six months of direct RN experience are eligible for a $20,000 sign-on bonus!**...care for orthopedic, abdominal, and general surgeries. 5 West appeals to anyone interested in broadening their skillset as… more
- Nuvance Health (Danbury, CT)
- …REQUIRED* * *Hybrid/Remote* * *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within ... in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- Beth Israel Lahey Health (Cambridge, MA)
- …high reliability processes to reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, ... skills to prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for medical peer review.… more
- Beth Israel Lahey Health (Plymouth, MA)
- …establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical ... team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding… 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 ... role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical ...NYS RN license, preferred + Holds, or will obtain within… more
- Elevance Health (Chicago, IL)
- …set of clinical domains, including radiology, cardiology and oncology. The ** Appeals Nurse Reviewer I** is responsible for conducting preauthorization, out ... ** Appeals Nurse Reviewer I** **Location:** This...reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. **How you will make an… more