- Stanford Health Care (Palo Alto, CA)
- …the Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and denials. This position requires ... regulations, payor policies, and industry best practices related to clinical appeals and denials management. Evaluate internal...Spec required within 180 Days + RN - Registered Nurse - State Licensure And/Or Compact State Licensure required… more
- Penn State Health (Hershey, PA)
- …that prohibit or outlaw discrimination._ **Union:** Non Bargained **Position** Clinical Appeals Nurse - Revenue Integrity Process **Location** US:PA: ... appropriate reimbursement for medically necessary services. This position requires strong clinical judgment, knowledge of payer guidelines, and the ability to craft… more
- Cognizant (Washington, DC)
- … cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . ... have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical ...stand out** . Epic experience . Experience in drafting appeals disputing inpatient clinical validations audits is… more
- St. Luke's University Health Network (Allentown, PA)
- …include volumes, number of appeals , case resolution, and impact on revenue and trending. + Facilitates retrospective clinical record reviews for ... regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all care sites ... need the following: Required Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and compliance functions necessary to effect accurate and complete ... supporting documentation, as well as facilitates the completion of appeals in a timely manner. + Prepares trend and...focus audits and reports findings. + Serves as a clinical resource for coding / denial management and customer… more
- Montrose Memorial Hospital (Montrose, CO)
- Montrose, CO, USA | Clinical Revenue Integrity | Hourly | 34.10-54.56 per hour 34.10 - 54.56 | Full Time | Medical, Dental, Vision, 401K with match, PTO About ... of healthcare. About the "Department" + Montrose Regional Health revenue integrity is the auditing and active monitoring to...billed to the patient. About The Career: + The Clinical Denial Analyst is a key contributor within the… more
- UCLA Health (Los Angeles, CA)
- Description The Utilization Review Nurse is part of the Utilization Management Department at the Resnick Neuropsychiatric Hospital, supporting inpatient, partial ... hospital, and intensive outpatient programs. Performs clinical reviews with third party payors in order to...party payors in order to obtain authorization, supporting the revenue cycle. Acts as a liaison between third party… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and ... + Root causes claim denials, reprocesses, and submits claim appeals . + Creates drug cost estimates for both on-label...plans that require prior authorization. + Serve as a clinical resource to the Revenue Integrity and… more
- Nuvance Health (Danbury, CT)
- …and operational oversight for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while partnering with local case ... to foster a culture of collaboration, patient-centered care, and revenue optimization. This leader empowers denials/ appeals specialists...nurse (RN) * Minimum of 5 years of clinical experience in an acute care setting * Minimum… 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 ... role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate efficient… more
- Houston Methodist (Sugar Land, TX)
- …or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of care for government ... **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -...care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge… more
- HCA Healthcare (Las Vegas, NV)
- …your application for the opportunity below: Inpatient Authorization Review Services- Registered Nurse or Licensed Practical Nurse - NICU (Code Pink) Parallon. ... We are seeking a Inpatient Authorization Review Services- Registered Nurse or Licensed Practical Nurse - NICU...the account being denied by the payor that require clinical expertise. Communicates with third party payors to resolve… more
- HCA Healthcare (San Antonio, TX)
- …organization that invests in you as an Inpatient Authorization Review Services Registered Nurse or Licensed Practical Nurse -NICU (Code Pink)? At Parallon, you ... looking for a dedicated Inpatient Authorization Review Services Registered Nurse or Licensed Practical Nurse -NICU (Code...the account being denied by the payor that require clinical expertise. Communicates with third party payors to resolve… 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 denial ... analyzes medical records and coding guidelines to formulate coding arguments for appeals and/or coding guidance for potential re-bills. Maintains a working knowledge… more
- Brockton Hospital (Brockton, MA)
- …include the development and supervision of staff (RNs, LPN's,SWs and non- clinical support), evaluation and maintenance of case management skills and outcomes, ... to optimize all roles. This position has significant impact on patient care revenue and expense and provides mission critical access to Hospital & Signature Medical… more
- Sharp HealthCare (San Diego, CA)
- …Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing; Bachelor's Degree in Nursing ... care areas. This position requires the ability to combine clinical /quality considerations with regulatory/financial/utilization review demands to assure patients are… more
- Sharp HealthCare (La Mesa, CA)
- …Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing **Hours** **:** **Shift Start ... care areas. This position requires the ability to combine clinical /quality considerations with regulatory/financial/utilization review demands to assure patients are… more
- Houston Methodist (Houston, TX)
- …and advancement of a unified case management model grounded in clinical excellence, throughput efficiency, care transitions, and denials prevention. A champion ... position promotes innovative strategies while fostering interprofessional collaboration across clinical and administrative domains. This position leads enterprise-wide initiatives… more
- Catholic Health Services (West Islip, NY)
- …but not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and Patient Access departments to ... ensure the most advantageous clinical and financial outcomes. + Supports all CH and...that result in development of efficient processes and enhanced revenue . + Provides guidance and education to the Care… more
