- Trinity Health (Farmington Hills, MI)
- …**MINIMUM QUALIFICATIONS** Must possess a demonstrated knowledge of denial management functions. Registered Nurse and a graduate of an accredited school of ... Work Remote Position (Pay Range: $34.9314-$52.3971) Responsible for reviewing all post-billed denials (inclusive of clinical denials ) for medical necessity and… more
- AdventHealth (Hinsdale, IL)
- …AND EXPERIENCE REQUIRED:** . Associates Degree Nursing or RN Diploma degree . Registered Nurse (RN) . Two (2) years of medical/hospital nursing experience ... **LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:** . State of Illinois registered nurse license **LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:**… more
- Alameda Health System (San Leandro, CA)
- …at a medical group or health plan. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California, Active BLS - Basic Life ... Care Management Clinical Appeals Specialist + San Leandro, CA + Finance +...based on identified criteria and ensures the patient is registered at the appropriate level of care; Utilizes McKesson… more
- BayCare Health System (Cotton Plant, AR)
- …Critical Care or Emergency Nursing RN. **Certifications and Licensures:** + Required RN ( Registered Nurse ) + Preferred ACM (Case Management) + Preferred CCM ... **BayCare Health System** is currently seeking a **Utilization Review Specialist Senior** to join our outstanding and compassionate team....2 years in Case Management + Preferred 3 years Registered Nurse in Critical Care or Emergency… more
- Tufts Medicine (Burlington, MA)
- …**Job Description** **Minimum Qualifications:** 1. Bachelor's Degree in Nursing 2. Active Registered Nurse (RN) license in Massachusetts or compact state 3. ... **Job Profile Summary** The role of the Clinical Documentation Integrity (CDI) Specialist III is responsible for concurrent and retrospect review and analysis of… more
- Albany Medical Center (Albany, NY)
- …steps to ensure no scheduling or authorization needs are missed. Qualifications: + Registered Nurse (RN) licensure, preferred. Thank you for your interest in ... Salary Range: Min. $23.96/hr - Max $38.34/hr The Clinical Pre-Authorization Specialist will assist the Patient Engagement Center Liaison, Representatives and other… more
- Corewell Health (Southfield, MI)
- …(CCDS) within 2 years of hire One of the following certifications upon hire: + Licensed Registered Nurse (RN) - State of Michigan or + Licensed Nurse ... to address problem areas identified through quality studies or claim denials working directly with physicians and other health care professionals. Essential… more
- Munson Healthcare (Traverse City, MI)
- …required to obtain a BSN within 5 years of start date. + Current licensure as Registered Nurse in the State of Michigan. + Minimum of three years clinical ... Updates all involved parties regarding potential, threatened or actual denials due to lack of medical necessity or barriers...external case managers Why work as a Utilization Review Specialist at Munson Healthcare? + Our dynamic work environment… more
- Carle (Urbana, IL)
- …required within five (5) years of start date. CERTIFICATION & LICENSURE REQUIREMENTS Registered Professional Nurse (RN) License Illinois upon hire and Basic Life ... RN - Clinical Transition Specialist + Department: IP Clinical Case Mgmt -...swing bed patients, maintain the work ques, and address denials . + RMH: make follow up appointments with primary… more
- AdventHealth (Orlando, FL)
- …expertise and experiences you'll need to succeed:** + Associate's degree in Nursing + Registered Nurse license from the state in which practicing + Home Care ... 1, stage 2) + Handles escalated clinical authorizations and denials , prioritizing timelines/limits **Accountability / Fiduciary:** + Identifies quality performance… more
- Sanford Health (SD)
- …Nursing Commission for Nursing Education Accreditation (NLN CNEA). Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing. ... chart review, and assisting with and managing of insurance coverage and denials , prior authorizations, scheduled procedures, same-day readmission reviews, as well as… more
- The Cigna Group (Bloomfield, CT)
- …as needed. + Additional duties as assigned. **Qualifications** + Education: Licensed Practical Nurse or Registered Nurse + 3-5 years' experience in ... Plan. These appeals will include requests for decisions regarding denials of medical services as well as Part B...as Part B and Part D drug. The Appeals Specialist will be responsible for analyzing and responding appropriately… more
- Access Dubuque (Dubuque, IA)
- …20240223 End Date 20240830 Featured Job 0 TH Ad 0 TH Comments **Similar Jobs** Registered Nurse - Psychiatric Services - FT - Nig MercyOne Patient Safety and ... Appeals appropriately and works to find root cause of denials . Thinks outside of the box to find solutions...Process Improvement Specialist UnityPoint Health Finley Hospital Staff Accountant Sr-Financial Plan… more
- AdventHealth (Shawnee, KS)
- …**EDUCATION AND EXPERIENCE REQUIRED:** Associate Degree Nursing or RN Diploma degree** Registered Nurse (RN)** Two (2) years of medical/hospital nursing ... patients who no longer meet medical necessity and escalates potential denials , documents avoidable days, and facilitates progression of care. Collaborates with… more