- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials ... JOB DUTIES AND RESPONSIBILITIES: + Reviews all Inpatient Retroactive Denials in the Denials Management ...an accredited, professional nursing program. + Must have current RN license to practice in the state of Pennsylvania… more
- Beth Israel Lahey Health (Plymouth, MA)
- …making a difference in people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who We Are:** At **Beth ... Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager, you will:** + Directs staff performance regarding UR and… more
- Houston Methodist (Sugar Land, TX)
- …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical… more
- Nuvance Health (Danbury, CT)
- …operations such as prior authorization, initial and concurrent review, and denials management into other internal and external teams/departments including ... Denials Management and Care Coordination * Conduct clinical assessments to...or utilization management required. * 5 years management experience preferred * RN License in… 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 ... Responsible for coordinating the appeals process for third party payer denials , primarily RAC-related activities and commercial appeals beyond the first level,… more
- Nuvance Health (Danbury, CT)
- …and trending all appeals and communicating on a daily/regular basis with the Denials Management team. * Assists with informing Managed Care contracting team ... This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to...required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting… more
- UC Health (Cincinnati, OH)
- …Services Under the supervision of the Manager of Denials -Charge Audits, the Denials Management (DM) nurse will use established criteria and ... UC Health is hiring a Full Time RN ( Denials /Charge Audits) for Patient Financial... regulations, registration, claims, and payor policies the Denial Management nurse will work assigned accounts to… more
- McLaren Health Care (Grand Blanc, MI)
- **Position Summary:** Responsible for assisting the Corporate Director Denials Management in providing regional management of day-today operation and ... workflow of the denials management team. Builds strong partnerships with service lines, key...degree in nursing or healthcare related field **.** Current Registered Nurse license in the state of… more
- Guthrie (Binghamton, NY)
- Summary The Registered Nurse ( RN ) Utilization Management (UM) in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices, ... of patient status. 1. Collaborate and set standards with registered nurse ( RN ) case managers...for information, data, and /or education specific to clinical denials management . 6. Collaborates with revenue cycle… 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 ... and strategy for system-wide care coordination, encompassing utilization review (UR), denials management , discharge planning, social work, and non-clinical… more
- Beth Israel Lahey Health (Plymouth, MA)
- …Transitions Department** and seeking an experienced **Manager of Utilization Review & Denials Management ** and **Utilization Review** **Nurses** to join our ... plays a vital role in ensuring seamless, patient-centered care. ** RN - Utilization Review** This role is ideal for...preferred or in progress **Manager - Utilization Review & Denials Management ** This role is ideal for… more
- HealthTrust Workforce Solutions (Myrtle Beach, SC)
- …access to more than 200,000 jobs nationwide. **_JOB SUMMARY_** The Interim Leader of Case Management Services is a Registered Nurse who participates as an ... and resource management , cost control, contract compliance, quality improvement, utilization management , denials management and management of… more
- RWJBarnabas Health (Newark, NJ)
- …payors, and patients and families + Excellent working knowledge of denials management + Knowledge of professional standards for RN Case Managers and Social ... Management Plan. Qualifications: Required: + BSN required for RN ; Master s Degree preferred, preferably in nursing +...+ Current and valid license to practice as a Registered Nurse or Social Worker in the… more
- Alameda Health System (Oakland, CA)
- …completion of financial analyses including cost of care to reimbursement, denials management , and non-reimbursed services, promoting effective resource ... Director, Inpatient System Care Management + Oakland, CA + Highland General Hospital...Preferred Experience: N/A Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California… more
- McLaren Health Care (Mount Clemens, MI)
- …and Responsibilities as Assigned:** 1. Supports activities consistent with Integrated Care Management Denials across all MHC subsidiaries. 2. Accountable for ... responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and… more
- Tufts Medicine (Burlington, MA)
- …**Minimum Qualifications for CDI level I:** 1. Associate's degree in Nursing 2. Active Registered Nurse ( RN ) license in Massachusetts or compact state 3. ... (ICU, ED, Critical Care, strong Med/Surg Specialty) OR case management , utilization review, or denials management...level II:** 1. Bachelor's Degree in Nursing 2. Active Registered Nurse ( RN ) license in… more
- Tufts Medicine (Burlington, MA)
- …**Job Description** **Minimum Qualifications:** 1. Bachelor's Degree in Nursing 2. Active Registered Nurse ( RN ) license in Massachusetts or compact ... setting (ICU, ED, Critical Care, strong Med/Surg Specialty) or equivalent case management , utilization review, denials management , or progressive leadership… more
- Houston Methodist (Houston, TX)
- …with HM performance that demonstrates leadership responsibility **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... At Houston Methodist, the Director Case Management & Social Services RN position...of opportunities for appropriate utilization of resources to avoid denials and resource management as it pertains… more
- Ellis Medicine (Schenectady, NY)
- …assist in utilization management activities under the direction of a registered nurse and/or social worker. Responsibilities include maintaining case files, ... Social Worker, Nurse Case Manager, or Utilization Management Nurse to facilitate patient discharge plans,...UM Coordinator with data entry of insurance authorizations and denials . + Denial Management Activities + Assists… more
- Geisinger (Scranton, PA)
- …Center (GCMC), providing direct support to inpatient hospital teams. Job Duties The Registered Nurse Care Manager works with physician and multidisciplinary team ... Experience Minimum of 3 years-Nursing (Required) Certification(s) and License(s) Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania OUR PURPOSE… more