- Ascension (Wichita, KS)
- Details Department: Utilization Management Schedule: Full-time, Day Shift, 40 hours/week, Monday-Friday, 8am-4:30pm Location: Wichita, KS - Must be located within ... offer. Responsibilities Provide health care services regarding admissions, case management , discharge planning and utilization review. Review admissions and service… more
- Fort Duncan Regional Medical Center (Eagle Pass, TX)
- …Manage department budget, staffing, and training needs. Function as Utilization Review/ Denials Manager as required. Qualifications Registered Nurse (RN) with ... Position Summary Lead and oversee the hospital's case management department, ensuring patients receive high-quality, efficient, and coordinated care from admission… more
- Riverside Health System (Hampton, VA)
- Hampton, Virginia Overview Responsible for the judicious management of health system resources through advocacy for both the patient and the organization. Provides ... stay medical necessity reviews and communicates the findings to physicians and Care Management team members based upon a thorough medical record review and knowledge… more
- BRISTOL HOSPITAL GROUP (Bristol, CT)
- …of service. Besides obtaining authorizations, The UM department is heavily involved in denials management , the appeal process, and the Peer to Peer review ... outlined in CFR 482.30 (Utilization Review) Finally, the UM nurse is expected to lead a denial management... nurse is expected to lead a denial management process and assist with appeal letter generation. Qualifications… more
- Plastic Surgical (Garden City, NY)
- …knowledge of CPT & ICD10 Coding Experience in working all insurance denials . Compensation: $23.00-$26.00 ABOUT US: New York Plastic Surgical Group, a division ... to bring our expertise in limb reattachment, complex wound and burn management , reconstructive cleft lip and palate repair, and other life-altering surgeries to… more
- Hebrew SeniorLife (Canton, MA)
- …staff communication according to HIPPA standards. Use appropriate practice management systems to schedule all appointments, greet arriving patients, capture ... demographics. Verify insurance at time of visit. Work closely with practice nurse to triage patients. Use electronic medical records system to maintain patient… more
- Total Safety (El Dorado, KS)
- Total Safety is looking for a Registered Nurse to add to their safety conscious team. The Registered Nurse will provide administrative, clerical and back-up ... medical support to customer site. Including, but not limited to: absence management , medical record maintenance, and other general administrative duties as assigned.… more
- Liberty Health (Lewisville, NC)
- There's no place like Liberty Healthcare Management Come explore career opportunities with Liberty Health , a dynamic leader in the healthcare industry. Join us! We ... insurance companies pay pharmacy claims Contact insurance companies related to denials , rejections and prior approvals on prescriptions/orders from SNF facilities.… more
- NewYork-Presbyterian Hospital (Brooklyn, NY)
- …Manager is responsible for all aspects of discharge planning and utilization management /review for an assigned group of patients to determine the appropriateness of ... admissions that requires risk identification and clinical reviews. A utilization nurse completes no less than 20 initial clinical reviews daily. Responsibilities… more
- Catholic Health Initiatives (Little Rock, AR)
- …as Registered Nurse (RN) 5 years of RN experience **Preferred** Denials management experience Previous case management , utilization management ... an integral role within the revenue cycle by providing clinical expertise in the denials management process. The Denials RN performs a root cause analysis of… more
- Trinity Health (Hartford, CT)
- …expertise as it relates to the preauthorization process + Coordinate denial management processes (ie, Initial Denials such as administrative/technical accounts, ... NAHAM strongly preferred + Knowledge of patient access, revenue cycle and denial management functions; technical and clinical denials areas, such as medical… more
- Children's Mercy Kansas City (Kansas City, MO)
- …lives of children beyond the walls of our hospital. Overview The High-Risk Nurse Lead manages high risk administrative processes and data related to medical ... necessity denials , clinical appeals, long length of stay rounds, and...for the patient population, hospital, care delivery model, care management practices, and payer contracting. Supports facilitation and tracking… more
- Houston Methodist (The Woodlands, TX)
- …manager, denials , and pre-bill team members, as well as management . **PEOPLE ESSENTIAL FUNCTIONS** + Establishes and maintains effective professional working ... At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a licensed registered...determinations (LCDs & NCDs). This position collaborates with case management in the development and implementation of the plan… more
- Children's Mercy Kansas City (Kansas City, MO)
- …beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes clinical expertise, evidence-based guidelines, insurance knowledge, ... contracts for medically appropriate level of care. Manages concurrent clinical denials through completion of verbal reconsideration process. Works with physicians… more
- Trinity Health (Ann Arbor, MI)
- **Employment Type:** Full time **Shift:** **Description:** Responsible for coordinating denials with Patient Business Service (PBS) center and ensures compliant and ... complete clinical documentation, assists with denials and related audits, and identifies opportunities for revenue optimization. Investigates denials and root… more
- Crouse Hospital (Syracuse, NY)
- …with Business Office staff regarding workflow processes and maintains an effective denials management process. + General operational oversight includes hiring, ... the RN Care Managers in the department, including Utilization Management , Discharge Planning and Denials and Appeals...Manager, Care Coordination Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree +… more
- Veterans Affairs, Veterans Health Administration (Leavenworth, KS)
- Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of the revenue ... within the scope of the CPAC for revenue reimbursement. The RUR nurse applies advanced clinical knowledge, communication skills, and collaboration to promote… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a **Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, Barksdale ... sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states.… more
- R1 RCM (Boise, ID)
- …will help our hospital clients by serving as an expert on appeals and denials management where claims were denied by either governmental contractors or ... patient care as well as conceptual knowledge of the denials landscape. Proficiency in basic computer skills is essential...what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical… more
- Essentia Health (Fargo, ND)
- **Job Description:** Seeking a Registered Nurse to serve in Essentia Health's pain clinic at our 32nd Avenue building in Fargo, North Dakota. This RN works 8 am to 5 ... and medications, ensuring timely disposal or replacement. 2. Supply and Medication Management - Monitor inventory levels of medical supplies and medications. - Order… more
