- MedStar Health (Baltimore, MD)
- …records of concurrent and retrospective denial activity in conjunction with Case Management support staff. Monitors and tracks denials and appeal results, ... Candidates with previous Utilization Review or Denials /Appeals experience preferred General Summary of Position Responsible for coordinating and monitoring the… more
- UF Health (Gainesville, FL)
- …planning, design, implementation, and oversight of UF Health Shands CDI Program and Denials Management Program. The CDI program aims to improve the overall ... to accurately reflect patient care in adherence to industry best practices. The Denials Management Program aims to analyze root causes to mitigate future… more
- Children's Mercy KC (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
- OneOncology LLC (Atlanta, GA)
- …and the clinical department. Performs related work as directed by the organization's management team. REQUIREMENTS: Active Registered Nurse (RN) license in the ... Here, you'll find purpose in your work. Job Description: The Clinical Nurse is responsible for providing comprehensive nursing care for patients with hematology… more
- Rogers Behavioral Health (Milwaukee, WI)
- …to sites within the scope of AHP licensure. Conduct medication management sessions with patients, Conduct patient medical evaluations and assessments, Conduct ... working relationships with all contracted payors. Review of all denials of service from all payors that are deemed...Be licensed in the state of Wisconsin as a nurse practitioner or physician assistant. Board-eligible AHP. Board certification… more
- Rogers Behavioral Health (Milwaukee, WI)
- …to sites within the scope of AHP licensure. Conduct medication management sessions with patients, Conduct patient psychiatric evaluations and assessments, Conduct ... working relationships with all contracted payors. Review of all denials of service from all payors that are deemed...Requirements : Be licensed in the state as a Nurse Practitioner or Physician Assistant Board-eligible AHP. Board certification… more
- UHS (Bradenton, FL)
- …wellness, improve care outcomes, efficient utilization of health services and minimize denials of payment among a patient population with complex health needs. ... REQUIRED LICENSURE/CERTIFICATION/REGISTRATION Description Required Preferred State of Florida Registered Nurse (RN) License Basic Life Support (BLS) Certification Case… more
- Children's Mercy KC (Kansas City, MO)
- …beyond the walls of our hospital. Overview The Director of Care Management responsible for providing leadership, strategic planning, and oversight of daily ... operations of the case management department which includes utilization management , care...and Workforce Engagement Oversees and directs the work of Nurse Case Managers, Social Workers, and Utilization Review specialist… more
- Franciscan Missionaries of Our Lady Health System (Baton Rouge, LA)
- …support the admission status and post-acute placement. g. Collaborates with Centralized Denials Management Department to coordinated appeal efforts to secure ... Job Description Under broad direction from the Centralized Utilization Management Manager, is responsible for the hospital-wide Utilization Management Programs… more
- 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
- SNCH (Oceanside, NY)
- …And Skills *Speaks, reads and writes English *5 years of clinical nurse experience *2 years of Case Management experience preferred License/Certifications ... Summary Summary: The Denial Review Coordinator is accountable for the management , coordination, and follow-up of all concurrent and retrospective inpatient clinical… more
- Nexus Health Systems (Spring, TX)
- …case managers/representatives and community agencies, demonstrating effective internal case management . Acquires appropriate information to address payor denials ... on patients as needed. Provides input to the Administrator regarding Case Management issues. Provides third-party payor sources with appropriate clinical updates as… more
- Texas Health Resources (Arlington, TX)
- …heavily on a team atmosphere and individual performance. *Highly engaged management Texas Health Arlington Memorial Hospital, a 369-bed acute-care, full-service ... discharge disposition, barriers to discharge, avoidable days, and potential denials . Communicates with the multidisciplinary team, patient, family, and post-acute… more
- The Judge Group Inc. (Philadelphia, PA)
- Job Posting: Registered Nurse - Case Manager (Day Shift) Schedule Details Shift: Day, 5x8-hour (08:00-16:30) Block Scheduling: Not available Weekend Requirement: ... Accepted Job Requirements Experience: Minimum 3 years in hospital case management Certifications Required: BSN BLS Charting System: Epic Patient Population: Adults… more
- Nexus Health Systems (Dallas, TX)
- …case managers/representatives and community agencies, demonstrating effective internal case management . *Acquires appropriate information to address payor denials ... patients as needed. *Provides input to the Administrator regarding Case Management issues. *Provides third-party payor sources with appropriate clinical updates as… 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
- 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
- Trinity Health (Ann Arbor, MI)
- **Employment Type:** Full time **Shift:** **Description:** Responsible for coordinating denials with Patient Business Service (PBS) center and ensures compliant and ... complete clinical documentation, assists with denials and related audits, and identifies opportunities for revenue optimization. Investigates denials and root… more
