- Jobleads-US (New York, NY)
- …in patient care and staff support. Requirements Active New York State (NYS) Registered Nurse (RN) License. Strong knowledge of Certified Home Health Agency ... Contribute to continuous performance improvement initiatives. Prepare and manage appeals processes. Track and manage grievances. Analyze patient satisfaction data… more
- Stanford Health Care (Palo Alto, CA)
- …role in the Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and denials. This position ... regulations, payor policies, and industry best practices related to clinical appeals and denials management. Evaluate internal...Document Spec required within 180 Days + RN - Registered Nurse - State Licensure And/Or Compact… more
- MVP Health Care (Schenectady, NY)
- …New York Qualifications you'll bring: Current New York State Licensure as a Registered Nurse required. Certification in Case Management required within 24 months ... after hire. At least 3 years of recent clinical and Case Management experience. Experience working in a...to maintain cost-effectiveness and manage Medical Loss Ratio (MLR). Appeals & Denials: Participate in the appeals … 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** ... other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed. + Encourages patients to develop realistic plans. Makes… more
- Cognizant (Lincoln, NE)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & Grievances ... (A&G) & General Operations ( Clinical ) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals & Grievances… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes ... regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes ...High School Diploma or GED **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact… more
- Penn State Health (Hershey, PA)
- …executive orders that prohibit or outlaw discrimination._ **Union:** Non Bargained **Position** Clinical Appeals Nurse - Revenue Integrity Process ... + Bachelor's degree in Nursing required. + Currently licensed to practice as a Registered Nurse by state of employment or holds a multistate RN license… more
- Elevance Health (Atlanta, GA)
- ** Nurse Appeals ** **Location:** This role enables associates...or BS in Nursing preferred. + 3 years of clinical experience as a Registered Nurse ... 8-hour shift between those hours, including holidays on a rotational basis. The ** Nurse Appeals ** is responsible for investigating and processing and medical… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate implementation of the clinical appeal process for ... and serves as a resource for associates within the Clinical Appeals and Analysis unit. We are...team-based performance as needed. **Licenses/Certifications** : + RN - Registered Nurse - State Licensure And/or Compact… more
- TEKsystems (San Bernardino, CA)
- Description We are seeking a dedicated Clinical Appeals Nurse to join our Revenue Cycle Management team. The ideal candidate will be responsible for managing ... support appeals , and following up on submitted appeals . The Clinical Appeals Specialist...with a team of Licensed Vocational Nurses (LVNs) and Registered Nurses (RNs) to ensure comprehensive and accurate appeal… more
- Centene Corporation (Jefferson City, MO)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... preferred. Knowledge of utilization management processes preferred. **License/Certification:** RN - Registered Nurse - State Licensure and/or Compact State… more
- Centene Corporation (Trenton, NJ)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... within the Eastern Standard Time Zone.** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals...Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact… more
- AmeriHealth Caritas (Philadelphia, PA)
- **Role Overview: ;** The Clinical Appeals Reviewer is responsible for processing appeals and ensuring all milestones are met in compliance with regulatory ... preferably within a managed care organization **Licensure:** + Current and unrestricted Registered Nurse (RN) licensure or compact state licensure **Skills &… 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. . ... of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding… more
- Catholic Health (Buffalo, NY)
- …finance, business management, operational analysis, information systems or related field + Registered Nurse with a four (4) year degree and Unrestricted ... based on role of management and oversight of team Summary: The Clinical Denials and Appeals , Clinical Supervisor is responsible for the people, carrying out… more
- Charter Care Health Partners (Providence, RI)
- Summary: The Clinical Appeals - Author performs appeals and denials management and represents the hospital where claims were denied by either governmental ... administrative duties as required. Education/Licensure: Medical Graduate, Physician Assistant or Registered Nurse (Current RI License) Experience: + Knowledge of… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …to improve provider performance and member satisfaction. Required Skills and Experience * Registered nurse with current MN license and no existing or pending ... Blue Shield of Minnesota Position Title: Care Manager PreService & Retrospective - Appeals Location: Remote Career Area: Health Services About Blue Cross and Blue… more
- State of Colorado (Denver, CO)
- Registered Nurse Health Compliance Inspector Home Care - FAA00601 (HP III RN) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5112485) Apply ... Registered Nurse Health Compliance Inspector Home Care...(RN) Health Professional III , you will use your clinical expertise to ensure quality of care, protect patient… more
