- Rush Copley Medical Center (Aurora, IL)
- **Position Summary** : The Appeals Specialist RN reviews inpatient hospital denials, clinical validation requests, and upheld denials after ... physician-to-physician (P2P) discussions then conducts appeals , as appropriate. Monitors and tracks denial outcomes with...with focus on Resolute Hospital Billing. **POSITION REQUIREMENTS** **License:** Registered Nurse ( RN ) in the… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB...or health plan. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California,… more
- Trinity Health (Farmington Hills, MI)
- …**MINIMUM QUALIFICATIONS** Must possess a demonstrated knowledge of denial management functions. Registered Nurse and a graduate of an accredited school of ... Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing… more
- Molina Healthcare (TX)
- **_For this position we are seeking a REGISTERED NURSE ( RN ) with prior experience in Utilization Review / Utilization Management and knowledge of Interqual / ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of… 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/4394165) Apply CDOC Registered Nurse ( Nurse I) Salary $7,442.00 Monthly Location Statewide,… more
- American Red Cross (Toledo, OH)
- …WHAT YOU NEED TO SUCCEED (Minimum Qualifications ): + Current state licensure as a Registered Nurse and CPR certification is required . + Bachelor's degree OR a ... alleviate human suffering. You can make a difference by volunteering in a position that appeals to you and allows you to use your unique skills and talents. The Red… more
- Baystate Health (Greenfield, MA)
- …**Summary:** The Utilization Management Specialist (UMS)/Hospital Case Manager (HCM) is a Registered Nurse ( RN ) responsible for the coordination of care, ... Franklin Medical Center** is looking for a **Per Diem** ** Registered Nurse ( RN ), Case Manager**...to retrieve and document clinical information accurately to track appeals cases and billing complaints. **3)** Conduct admission reviews… more
- Hackensack Meridian Health (Hackensack, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Appeal Nurse Specialist ** will be responsible for the timely review and submission of ... and Care Management). **Responsibilities** A day in the life of a **Appeal Nurse Specialist ** at **Hackensack Meridian** **_Health_** includes: + Reviews all… more
- Louisiana Department of State Civil Service (LA)
- …be filled as a Probationary appointment. Preference given to applicants with a LA Registered Nurse Licensure. No Civil Service test scoreis required in order to ... Entrance Rate (SER)for employees that are in possession of a valid Louisiana registered nurse license to practice professional nursing, a multi-state license… more
- CVS Health (Columbus, OH)
- …A Brief OverviewAdministers review and resolution of clinical complaints and appeals . Interprets data obtained from clinical records to apply appropriate clinical ... support areas. What you will doActs as a top-level specialist to implement best in class policies, plans, and...class policies, plans, and procedures in support of the Appeals area objectives.Executes review of all clinical and benefit… more
- Tarrytown Rehabilitation & Nursing Center (Everett, MA)
- …the recruitment/interview process for MDS and MMQ vacancies. Qualifications: + Licensed as a Registered Nurse in the State of Massachusetts + Three to Five years ... CLINICAL REIMBURSEMENT SPECIALIST / MULTI FACILITY We offer competitive compensation and...(Medicaid, Medicare) and case management process (prior authorization and appeals ) required + Ability to multi-task and adapt to… more
- Trinity Health (Des Moines, IA)
- …health administration or related field required. + Iowa licensure as a Registered Nurse . + Member of a professional healthcare organization.Demonstrated ... Full time **Shift:** Day Shift **Description:** The purpose of the Clinical Integration Specialist is to assist and support the Director in quality and safety… more
- Tenet Healthcare (Detroit, MI)
- …or health care field, or equivalent combination of education and/or related experience. Registered Nurse preferred. 2. Two to three years progressively more ... Quality Improvement Specialist PT Days - 2406002130 Description : Children’s...accurate entries. Communicates with third party payors and develops appeals to overturn adverse payment decisions; provides technical assistance… more
- BrightSpring Health Services (Louisville, KY)
- Our Company BrightSpring Health Services Overview The Clinical Coding and Audit Specialist monitors, responds and performs the clinical coding and audit support ... processing of all episodes of care. Reviews documentation for appeals processes across the Home Health enterprise for all...billing Qualifications + Clinical review positions will require a RN degree in nursing from an accredited or approved… more
- American Red Cross (Philadelphia, PA)
- …offering a $7,000- Sign-On Bonus WHAT YOU NEED TO SUCCEED (Minimum Qualifications): + Registered Nurse with current state licensure as required. + A minimum of ... alleviate human suffering. You can make a difference by volunteering in a position that appeals to you and allows you to use your unique skills and talents. The Red… more
- HCA Healthcare (Asheville, NC)
- …diversity and inclusion thrive? Submit your application for our Insurance and Claims Specialist (Program of All Inclusive Care for the Elderly) Program opening with ... vary by location._** We are seeking Insurance and Claims Specialist PACE Program, for our team to ensure that...network vendors regarding claims processing and payment concerns and appeals as necessary to facilitate the accounts payable process… more
- Healthfirst (NY)
- …Termination, and Suspension of services. The end to end process requires the Specialist to independently: + Research issues + Reference and understand HFs internal ... + Work within a framework that measures productivity and quality for each Specialist against expectations + Prepare cases for Medical Director Review ensuring that… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and approve medically… more
- Universal Health Services (Groton, CT)
- …Services, Inc. (UHS), has an immediate opening for a full-time UR Specialist . Stonington Institute is committed to providing quality substance abuse treatment ... and the United Kingdom. www.uhs.com Job Summary: The Utilization Review Specialist is responsible for the pre-certification, concurrent, and discharge review process… more
- State of Colorado (CO)
- …Rights MINIMUM QUALIFICATIONS: + Applicant must possess a current, valid license as a Registered Nurse from the Colorado Board of Nursing or any state ... years of full-time experience providing patient care as a Registered Nurse . W ork experience less than...of the department's action. For more information about the appeals process, the official appeal form, and how to… more