- The LaSalle Group (Evanston, IL)
- …- 4:00 PM (Latest start time: 8:00 AM) Position Summary: We are actively hiring Registered Nurse ( RN ) Clinical Appeals Specialists to join our client's ... will have a strong focus on resolving complex clinical denials through evidence-based appeals. The Clinical Appeals Specialist...in Epic and other relevant systems. Required Qualifications: Active Registered Nurse ( RN ) license in… more
- Baptist Memorial Health Care Corporation (Memphis, TN)
- Overview Specialist -Denial Mitigation II RN Job Code : 21432 FLSA Status Job Family : FINANCE Job Summary * Position may be filled in Memphis, TN; Jackson , MS ... The Denial Mitigation-Appeal Specialist II RN serves in a key...along to healthcare insurance providers in response to post-claim denials received by BMHCC. Physician Advisor communication may be… more
- Generis Tek, Inc. (Gainesville, FL)
- …To discuss this amazing opportunity, reach out to our Talent Acquisition Specialist Anshik Kulshrestha at email address ###@generistek.com can be reached on # ... ###. We have Permanent role Case Manager RN for our client at Gainesville, FL. Please let...and families as appropriate. Assists in management of payor denials ; issues hospital-initiated notices of non-coverage (HINN's) Distinguishes between… more
- AdventHealth (Hinsdale, IL)
- …for individuals from at-risk populations from interdisciplinary team members (including physicians, RN Care Managers, staff nurses, and other members of the care ... patients who no longer meet medical necessity and escalates potential denials , documents avoidable days, and facilitates progression of care. *Collaborates with… more
- 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 ... and tracks outcomes regarding appeal process. Assists billing staff regarding outpatient denials for experimental, coding or other issues that may require record… more
- CenterWell (Honolulu, HI)
- …or requested. **Use your skills to make an impact** **Required Experience/Skills:** + Registered Nurse or Physical Therapist. + Current state license as a ... caring community and help us put health first** The ** Denials Management Specialist ** is responsible to respond... Registered Nurse or Physical Therapist. + 5... Registered Nurse or Physical Therapist. + 5 years of professional… more
- AdventHealth (La Grange, IL)
- …resolution skills . Teamwork principles **EDUCATION AND EXPERIENCE REQUIRED:** . Associates Degree Nursing or RN Diploma degree . Registered Nurse ( RN ) . ... **LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:** . State of Illinois registered nurse license **LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:**… more
- AdventHealth (Hinsdale, IL)
- …for Discharge Planning + Conflict management and resolution skills + Teamwork principles + Registered Nurse ( RN ) Required + Certified Case Manager (CCM) ... 120 N OAK ST, Hinsdale, 60521 **The role you'll contribute:** The RN Care Manager in collaboration with the patient/family, social workers, nurses, physicians… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse ( RN ) who comprehensively conducts point ... entry, observation progression of care management, concurrent review and denials reviews. Additionally, the URSN will prospectively or concurrently...in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- St. Luke's University Health Network (Allentown, PA)
- …Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. . ... a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews...and procedure code assignment and MS-DRG/APR-DRG accuracy based on denials or audit findings from government and commercial payers.… more
- HonorHealth (AZ)
- …1 year experience in UR/UM or Case Management Required Licenses and Certifications Registered Nurse ( RN ) State And/Or Compact State Licensure Required ... more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of...from an accredited NLN/CCNE institution Required Experience 3 years Registered Nurse in an acute care setting.… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. ... molecular pathology, high-cost drug, and off-label drug authorizations. The Clinical Authorization Specialist is also responsible for managing denials related to… more
- UPMC (Pittsburgh, PA)
- … Health Information Administrator OR Registered Health Information Technician (RHIT) OR Registered Nurse ( RN ) + Act 34 *Current licensure either in ... UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within our... (CCS) OR Certified Professional Coder (CPC) OR Certified Registered Nurse Practitioner OR Doctor of Medicine… 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 for evaluating the necessity, appropriateness, and efficiency of hospital services to… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Clinical Documentation Integrity Specialist Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the region's ... be named a Forbes "Best Employer" seven times. Position Summary: The CDI Specialist serves as liaison between the physicians and hospital departments to promote… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Therapy and/or Prior Authorization experience is preferred. + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. **KNOWLEDGE, SKILLS, ... The Cell Therapy Clinical Authorization Specialist is responsible for the comprehensive coordination and...initial and ongoing authorizations, monitor payer-specific requirements, and resolve denials and claim issues to ensure timely access to… more
- St. Mary's Healthcare (Amsterdam, NY)
- …Improvement Specialists obtained prior to hire date or job transfer date. * Registered Nurse credentialed from the New York Board of Nursing obtained ... and coding to maximize documentation, ensure compliance and reduce denials * Works with case management and the admit...One or more of the following: * Certified Coding Specialist (CCS) credentialed from the American Health Information Management… more
- Hartford HealthCare (Farmington, CT)
- …Business Office in Newington. *_Position Summary:_* The Revenue Integrity Specialist determines the appropriateness of patient charges, and Charge Description ... and completeness, following regulatory requirements, in order to resolve edits, denials or exceptions detected during system processing of the claim. *_Position… more
- Catholic Health Initiatives (Omaha, NE)
- …Commonspirit Health Facility Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact patient care and optimize ... experience.** Medical Coding experience is a plus! As our Utilization Review RN , you will be responsible for conducting comprehensive reviews of medical records… more
- Penn Medicine (Philadelphia, PA)
- …8a-4:30p, Remote The Health Information Management (HIM) Clinical Documentation Specialist will oversee organization-wide system for improving clinical documentation ... departmental and health system quality initiatives. Process clinical validation denials by disputing payer payment reductions when appropriate through identification… more
