- Monster (Orange, CA)
- Job Title: Temporary - Grievance & Appeals Nurse Specialist Department: Grievance & Appeals Work Arrangement: Onsite (Full Office) Schedule: Monday - ... About the Role: Client is seeking a Grievance & Appeals Nurse Specialist (Temporary) to... (LVN) license in California. Preferred Qualifications: Current unrestricted Registered Nurse ( RN ) license in… more
- Monster (Allentown, PA)
- …near vision, visual monotony. EDUCATION: Graduate of an accredited professional nursing program. Registered nurse with current license to practice in the state ... ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for...preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending.… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for ... will need the following: Required Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with… 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 ... ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for...preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending.… more
- Molina Healthcare (Omaha, NE)
- … decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- Beth Israel Lahey Health (Cambridge, MA)
- …to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality data by ... on the key performance indicators and quality measures, the RN specialist also aims to foster a...reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… 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
- City and County of San Francisco (San Francisco, CA)
- …( RN ) license issued by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a valid Clinical ... designing and implementing plans for meeting such needs. The Clinical Nurse Specialist performs other...as assigned/required. Minimum Qualifications + License and Certification: + Registered Nurse License: Possession of a valid… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve ... experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred.… more
- Independent Health (Buffalo, NY)
- …(RHIA), Registered Health Information Technician (RHIT), Certified Clinical Documentation Specialist (CCDS), American Health Information Management ... coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with… 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...conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate… more
- Houston Methodist (Sugar Land, TX)
- …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... review, case management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of… more
- UHS (Binghamton, NY)
- …(5) years of experience in acute/tertiary facility. + Minimum Required: NYS Licensed Registered Nurse Preferred: + Bachelor's of Science in Nursing with three ... Position OverviewUnited Health Services (UHS) is seeking a proactive and analytical Clinical Denials Specialist to join our Revenue Cycle team. In this vital… more
- BriteLife Recovery (Englewood, NJ)
- …clinical information and advocating for appropriate levels of care. The UR Specialist works closely with clinical staff, admissions, medical providers, and ... What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible for… more
- State of Colorado (Sterling, CO)
- …Rights MINIMUM QUALIFICATIONS: + Applicant must possess a current, valid license as a Registered Nurse from the Colorado Board of Nursing or any state ... III 30492 09/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 09/09/2025 Closing Date...years of full-time experience providing patient care as a Registered Nurse . W ork experience less than… more
- State of Colorado (Denver, CO)
- …their job duties. This position works under the supervision and direction of a registered nurse and assists with psychiatric nursing care of mentally ill ... include: Provide Therapeutic Patient Care: Under the direction and supervision of a registered nurse , engage with patients to establish and maintain a… more
- State of Colorado (Limon, CO)
- …with accessibility in mind. Preferred Qualifications: + A current, valid license as a Registered Nurse from the Colorado Board of Nursing, or any state ... This position provides operational and supervisory oversight of multi-disciplinary clinical services staff working at the Limon Correctional Facility....active license from the State of Colorado as a Registered Nurse or Nurse Practitioner?… more
- State of Colorado (Denver, CO)
- …assistance to patients in a clinical setting under the direction of a registered nurse at the Denver Complex. This position is responsible for, but not ... limited to, the following: + In a clinical setting, assist patients with activities of daily living...skin condition and patient health care complaints to shift registered nurse ; + Empty catheter bags; offer… more
- Children's Mercy Kansas City (Kansas City, MO)
- …Utilization Review, and Performance Improvement Leadership + One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required ... Nurse Case Managers, Social Workers, and Utilization Review specialist team members and support staff + Analyzes, evaluates,...upon hire + One of the following: Licensed RN - Kansas, Registered Nurse … more
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