- 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...with regulatory standards and organizational policies. You will investigate appeals , prepare clinical case narratives, and represent… more
- Monster (Allentown, PA)
- …of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks ... Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending. Coordinates RAC … more
- Molina Healthcare (Omaha, NE)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...more of the following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist … more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …resources to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison ... need the following: Required Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive… more
- City and County of San Francisco (San Francisco, CA)
- …and assists with designing and implementing plans for meeting such needs. The Clinical Nurse Specialist performs other related duties as assigned/required. ... by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… 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 ... reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review...prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks ... + Assists in preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending. + Coordinates RAC … 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 ... Reporting to the Prior Authorization Superv isor , the Clinical Authorization Specialist is responsible for managing...+ Root causes claim denials, reprocesses, and submits claim appeals . + Creates drug cost estimates for both on-label… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- UHS (Binghamton, NY)
- Position OverviewUnited Health Services (UHS) is seeking a proactive and analytical Clinical Denials Specialist to join our Revenue Cycle team. In this vital ... role, you will focus on the prevention and resolution of clinical claim denials by analyzing denial patterns, investigating and appealing denied claims, and… more
- Houston Methodist (Sugar Land, TX)
- …management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of care for ... and billing processes, managed care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of CPT and ICD… more
- Mount Sinai Health System (New York, NY)
- …for appeals , On / Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days...Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status… more
- Fairview Health Services (St. Paul, MN)
- …the development of denial reports and other statistical reports. + Collaborates with Clinical Denials Nurse Specialist and Leadership in high-dollar claim ... **Job Overview** The Inpatient Coding Denials Specialist performs appropriate efforts to ensure receipt of...records and coding guidelines to formulate coding arguments for appeals and/or coding guidance for potential re-bills. Maintains a… more
- State of Colorado (Sterling, CO)
- Nurse Supervisor - Sterling Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5072854) Apply Nurse Supervisor - Sterling Salary $8,369.00 - ... $11,717.00 Monthly Location Sterling, CO Job Type Full Time Job Number Nurse III 30492 09/2025 Department Department of Corrections Division Clinical and… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4963973) Apply CDOC Registered Nurse ( Nurse I) ... $10,627.00 Monthly Location Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 06/2025 Department Department of Corrections Division Clinical and… more
- State of Colorado (Denver, CO)
- CDOC Licensed Practical Nurse (LPN) - DENVER Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5081868) Apply CDOC Licensed Practical Nurse ... treatment plans, employs infection control measures, provides referral to appropriate Clinical Services staff for new arrivals, crisis intervention, interviews and… more
- State of Colorado (Denver, CO)
- Quality Management Specialist (HEALTH PROFESSIONAL III) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5070297) Apply Quality Management ... Specialist (HEALTH PROFESSIONAL III) Salary $5,288.00 - $6,347.00 Monthly...regulatory standards. + Tracks data to improve operational and clinical performance and promote accountability and transparency. + Collaborates… more
- Trinity Health (Livonia, MI)
- …including but not limited to, appending modifiers, and checking clinical documentation. Provides feedback to intra-departmental Revenue Integrity colleagues ... Maintains productivity standards Maintains compliance with regulatory requirements Assist Nurse Auditor and/or Coordinator with denial coordination process; including… more
- BrightSpring Health Services (Louisville, KY)
- Our Company Signature Advantage Overview The Provider Services Specialist is responsible for overseeing aspects of the provider credentialing and recredentialing ... to provider inquiries. . Resolve escalated provider complaints, grievances, disputes and appeals in collaboration with other departments. . Ensure call center or… more
- Mindful Support Services (Goodyear, AZ)
- …Support Services is a company dedicated to empowering therapists, psychologists and nurse practitioners to dive into private practice, without doing all of the ... both personally and professionally. About the role: The Insurance Follow-Up Specialist is responsible for reviewing rejected claims, posting insurance payments, and… more
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