- St. Luke's University Health Network (Allentown, PA)
- …communities we serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party ... JOB DUTIES AND RESPONSIBILITIES: + Reviews all Inpatient Retroactive Denials in the Denials Management ...an accredited, professional nursing program. + Must have current RN license to practice in the state of Pennsylvania… more
- CenterWell (Honolulu, HI)
- **Become a part of our caring community and help us put health first** The ** Denials Management Specialist ** is responsible to respond to, monitor and ... or requested. **Use your skills to make an impact** **Required Experience/Skills:** + Registered Nurse or Physical Therapist. + Current state license as a… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the ... and denials for no authorization. The Senior Denials Management Specialist position communicates...nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… 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)
- …Planning + Conflict management and resolution skills + Teamwork principles + Registered Nurse ( RN ) Required + Certified Case Manager (CCM) Preferred ... transitions, patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the… more
- Houston Methodist (Sugar Land, TX)
- …includes three years in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure ... At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered ...functions through point of entry, observation progression of care management , concurrent review and denials reviews. Additionally,… more
- Baptist Memorial (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
- 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, ... Specialist is responsible for the comprehensive coordination and management of all prior authorization activities specific to cellular therapy services.… 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...Specialist (CCS) credentialed from the American Health Information Management Association (AHIMA) obtained prior to hire date or… more
- Trinity Health (Athens, GA)
- …with attending physicians, Physician Advisors, and external payors. Participates in denials management and auditing duties as assigned. Participates in ... insurance reviews based on contractual obligations. Actively manages concurrent denials . Demonstrates service excellence by providing complete clinical information… more
- Hartford HealthCare (Farmington, CT)
- …now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system. ... Business Office in Newington. *_Position Summary:_* The Revenue Integrity Specialist determines the appropriateness of patient charges, and Charge Description… more
- Penn Medicine (Philadelphia, PA)
- …1500 Market Street Hours: M-F 8a-4:30p, Remote The Health Information Management (HIM) Clinical Documentation Specialist will oversee organization-wide system ... throughout the organization that requires coding and documentation knowledge. Assist Coding Management staff in performing quality audits on coding staff and assist… 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
- Nuvance Health (Danbury, CT)
- …week) ; rotate one weekend per month Summary: The purpose of the Utilization Management Nurse is to support the physician, the interdisciplinary team, and ... Review experience(or a certification ACMA, MCG, Interqual) Required : CT Registered Nurse License Working Conditions: Manual: significant manual skills/motor… more