- 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
- Children's Health (Dallas, TX)
- … Nurses to monitor and resolve quality opportunities for appropriate authorization; and Denials Management Specialist to analyze denial data, propose and execute ... Job Title & Specialty Area: Prospective Review RN Department: Utilization Management Location: Dallas Shift: Day Job Type: Remote (This position does require on site… more
- Boston Childrens Hospital (Boston, MA)
- …level of care for admissions and with post-discharge appeals of payer denials . They identify and implement initiatives to manage utilization trends, collaborating ... requirements, length of stay, resource allocation, funding sources, and capacity management to optimize delivery of appropriate services. Actively participating in… more
- Memorial Hermann Health System (Pearland, TX)
- …information to payors. The role integrates and coordinates resource utilization management , care facilitation and discharge planning functions. In addition, the Case ... 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
- Pennsylvania Medicine (Plainsboro, NJ)
- …proactively identify potential denials in order to avoid non-appealable denials ; Credentials: Registered Nurse - NJ (Required) Certified Case Manager ... accurate information to payors. The role integrates and coordinates utilization management , care facilitation and discharge planning functions. In addition, the Case… more
- Children's National Hospital (Washington, DC)
- …in a pediatric setting. (Required) Required Licenses and Certifications Registered Nurse (Required) Current certification in Case Management (Preferred) ... The Case Manager II will provide case management services to patients and their families or...level). Participates in community activities. Patient Resource Services Communicate denials , high risk, or changes in level of care… more
- Kaiser Permanente (Seattle, WA)
- …seamless admissions, transfers, and discharges to minimize diversions, delays, or denials of patients. Functions as on-site administrative representative in the ... to four (4) hours. Communicates at Huddles and directly with Charge Nurse to: Review current patients. Identify pending/potential discharges. Determine capacity for… more
- Advocate Aurora Health (Wake Forest, NC)
- Department: 36510 Wake Forest Baptist Medical Center - Wound Management Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional ... Information: Varies License Practical Nursing (LPN), Wound Management Winston Salem NC, United States Are you a...States Are you a dedicated and compassionate Licensed Practical Nurse LPN looking to make a significant impact on… more
- Mount Sinai Hospital (New York, NY)
- …staff such as secretarial/administrative assistants, medical assistants, schedulers, data management and medical records staff. Ensures the successful delivery of ... preparation of budgetary recommendations. 6.Reviews and monitors daily statistics of denials and accounts reviewed by staff. Assesses accounts for collection… more
- Athens Health and Rehabilitation LLC (Huntsville, AL)
- …services at the highest practicable level for each resident. Provides case management services for certain high-risk Medicare Part A residents to ensure services ... the plan of care. QUALIFICATIONS Must be a Registered Nurse in good standing in the state(s) in which...in gathering information for Medicare and Medicaid appeals and denials as requested. During facility visits, conducts an exit… 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
- MedCadre (Waimea, HI)
- …supplies; and handle other clerical duties as assigned by supervisor, physician, or nurse . 6. Maintains decorum of the reception area. B. Patient Information ... Management & Scheduling Coordination 20% 1. Assist with following...for unpaid accounts; work with Clinic Business Office regarding denials /rejections and submit additional information as required. 2. Complete… more
- TerraBella Senior Living (Charlotte, NC)
- …Licensed Registered Nurse in good standing Five (5) year nursing management experience Benefits: In addition to a rewarding career and competitive salary, ... to the development, implementation and ongoing support of quality management and educational initiatives throughout assigned communities. This position assumes… more
- Rogers Behavioral Health (Milwaukee, WI)
- …quality assurance and peer review evaluations. Physicians will collaborate with nurse practitioners and physician assistants, as well as interact with residents ... will continue to see patients on unit seen by Nurse Practitioners and Physician Assistants and serve as a...patient assessments, and medication evaluations. b. 1:1 therapy, medication management sessions with patients. c. Weekly (or more often)… more
- Liberty Health (Lewisville, NC)
- There's no place like Liberty Healthcare Management Come explore career opportunities with Liberty Health , a dynamic leader in the healthcare industry. Join us! We ... insurance companies pay pharmacy claims Contact insurance companies related to denials , rejections and prior approvals on prescriptions/orders from SNF facilities.… 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
