- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is seeking a highly motivated and results-driven **UM RN Appeals Coordinator.** This role collaborates with clinical review staff, ... evenings and weekends, to address pharmacy-related denials + Educates physician reviewers and clinical review staff on managed care and Medicaid policies and… more
- Stanford Health Care (Palo Alto, CA)
- …Days or + CCDS - Cert Clinical Document Spec required within 180 Days + RN - Registered Nurse - State Licensure And/Or Compact State Licensure required . ... Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and...likelihood of a successful appeal. + Proofreading and Editing: Review and edit appeals for clarity and… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …appeals and acquire authorizations for treatment **Key Qualifications:** + Current NYS Registered Nurse License/Registration and BSN preferred + At least 2-3 ... Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of… more
- Alameda Health System (San Leandro, CA)
- …AHA-American Heart Association. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. **PAY RANGE** ... SLH Case Manager RN + San Leandro, CA + San Leandro...Two years related in acute care facility and/or utilization review training. Minimum Experience: Varied clinical experience… more
- St. Luke's University Health Network (Allentown, PA)
- …communities we serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- Centene Corporation (Salem, OR)
- …that all appeal letters generated comply with both State and NCQA requirements. + Review clinical information for all appeals utilizing nationally recognized ... RN or LPN** **Oregon state license **Utilization review , case management, and appeals experience in...report verbal and written information regarding member and provider clinical appeals , including information follow up +… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse ( RN ) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & ... + Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and… more
- Cognizant (Washington, DC)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...as well as timely filing deadlines and processes. . Review clinical denials including but not limited… more
- CVS Health (Hartford, CT)
- …it all with heart, each and every day. **Position Summary** Responsible for the review and resolution of clinical appeals . Reviews documentation and ... unrestricted RN licensure in state of residence * 3+ years clinical experience **Preferred Qualifications** * Appeals Experience * Managed Care Experience… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Appeals regulatory guidelines including URAC, NCQA, and ERISA + Proficiency in Clinical Appeals , Utilization Review , and Grievance processes including ... to its clients, ensuring high-quality, clinically sound decision-making. The Clinical Appeal and Grievance Nurse is responsible...throughout employment + Minimum of 5 years' experience in Clinical Appeals and Grievances within a managed… more
- State of Colorado (Denver, CO)
- …(HP III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5112485) Apply Registered Nurse Health Compliance Inspector Home Care - ... health, safety, and well-being of Colorado communities. As a Registered Nurse ( RN ) Health Professional...through direct observation, staff and consumer interviews, and record review . + Applying professional judgment and clinical … more
- State of Colorado (Denver, CO)
- …III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5084845) Apply Registered Nurse , Health Compliance Inspector, Complaints ... Registered Nurse , Health Compliance Inspector, Complaints...Section - FAA00710 (HP III RN ) Salary $80,916.00 Annually Location Denver, CO Job Type… more
- State of Colorado (Denver, CO)
- …III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5120373) Apply Registered Nurse Health Compliance Inspector, Nursing ... Registered Nurse Health Compliance Inspector, Nursing...Facilities - FAA00221 (HP III RN ) Salary $80,916.00 Annually Location Denver, CO Job Type… more
- State of Colorado (Lakewood, CO)
- Registered Nurse I, RN I - Campus at Mount View, Youth Services Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5115656) Apply ... Registered Nurse I, RN I...including physical, psychiatric and dental maintenance. Specific Job Duties: Clinical Duties: Initial nursing assessments and triage of requests… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …with resources to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management ... Required Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse...Nurse . 3 years with progressive experience in utilization review , preferred. Prior experience writing clinical denial… more
- HCA Healthcare (Nashville, TN)
- …TX, UT, VA). Do you want to join an organization that invests in you as a Clinical Appeals Specialist Medicare RN or LPN? At Parallon, you come first. HCA ... make a difference. We are looking for a dedicated Clinical Appeals Specialist Medicare RN ...today! What you will do in this role: + Review medical records and other documentation to compose RAC… more
- Nuvance Health (Danbury, CT)
- …REQUIRED* * *Hybrid/Remote* * *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within ... critical part in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with CMS requirements,… more
- CareFirst (Baltimore, MD)
- …strategies to improve individual and team-based performance as needed. **Licenses/Certifications** : + RN - Registered Nurse - State Licensure And/or Compact ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates...appeals and reconsiderations, including Regulatory complaints and External review requests. Accountable for quality review and… 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/4963973) Apply CDOC Registered Nurse ( Nurse I) Salary $7,591.00 - $10,627.00 Monthly… more
- Sacramento County (Sacramento, CA)
- …read and understood the above instructions. 02 Select the one box that best describes your Registered Nurse ( RN ) license issued by the State of California. + ... Registered Nurse D/CF (Level I/II) Print...+ Use and care of medical equipment used in clinical and infirmary settings + Basic medical indications of… more
