• Registered Nurse Clinical…

    Catholic Health (Buffalo, NY)
    …as related to DRG and level of care denial trends. Responsibilities: EDUCATION + Registered Nurse with a current New York State license + Bachelor of ... of root cause and process improvement opportunities to eliminate recurring clinical denials . The position acts as a liaison between front-end clinical areas and… more
    Catholic Health (02/14/24)
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  • Clinical Payment Resolution Specialist

    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: $34.0638-$51.0961) Responsible for reviewing all post-billed denials (inclusive of clinical denials ) for medical necessity and… more
    Trinity Health (03/13/24)
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  • Registered Nurse RN Care Manager

    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
    AdventHealth (01/26/24)
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  • Registered Nurse RN Care ManagerPRN

    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
    AdventHealth (01/25/24)
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  • Care Management Clinical Appeals Specialist

    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
    Alameda Health System (02/09/24)
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  • Utilization Review Specialist Senior

    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
    BayCare Health System (01/16/24)
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  • UR Clinical Specialist - RN

    Community Health Systems (Brooksville, FL)
    …Day shift with Weekend Rotation Bravera Health Spring Hill is hiring for a Registered Nurse Utilization Review Clinical Specialist to enhance the quality ... **Description** **$15,000 SIGN ON BONUSES FOR ELIGIBLE FT REGISTERED NURSE CANDIDATES** As a ...and/or corporate policies/procedures. + In the event of concurrent denials , the UR Clinical Specialist reviews the… more
    Community Health Systems (02/19/24)
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  • Clinical Pre-Authorization Specialist

    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
    Albany Medical Center (01/17/24)
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  • RN Specialist Utilization Review Per Diem

    HonorHealth (Scottsdale, AZ)
    …Degree in Nursing from an accredited NLN/CCNE institution Required Experience 3 years Registered Nurse in an acute care setting. Required 1 year experience ... in UR/UM or Case Management Required Licenses and Certifications Registered Nurse (RN) State And/Or Compact State Licensure Required more
    HonorHealth (03/14/24)
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  • Clinical Documentation Specialist Senior

    Corewell Health (Grand Rapids, MI)
    …of relevant experience Clinical Role Required + Clinical Documentation Review Preferred + LIC- Registered Nurse (RN) - STATE_MI State of Michigan Upon Hire ... address problem areas identified through quality studies or claim denials working directly with physicians and other health care...required Or + LIC- Nurse Practitioner (NP) - STATE_MI State of Michigan Upon… more
    Corewell Health (03/22/24)
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  • Clinical Documentation Integrity Specialist

    Carle (Urbana, IL)
    …REQUIREMENTS Associate's Degree in Related field CERTIFICATION & LICENSURE REQUIREMENTS Registered Professional Nurse (RN) License State of IL Nursing ... Clinical Documentation Integrity Specialist + Department: Health Information Management + Entity:...if licensed in another state within 6 months or Registered Health Information Admin (AHIMA) upon hire or Medical… more
    Carle (03/15/24)
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  • RN - Clinical Transition Specialist

    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
    Carle (03/27/24)
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  • Utilization Review Specialist

    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
    Munson Healthcare (02/24/24)
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  • Case Management Specialist

    University of Utah Health (Salt Lake City, UT)
    …Review or Case Management experience. **Licenses Required** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one within 90 ... and frequent utilizers. + Collaborate with unit case manager, utilization review nurse and other organization staff on establishing an appropriate plan to support… more
    University of Utah Health (01/25/24)
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  • Utilization Management Specialist

    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
    Sanford Health (03/23/24)
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  • Quality Review Specialist Part-Time Home…

    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
    AdventHealth (03/14/24)
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  • RN Care Manager Weekend Worker Program

    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
    AdventHealth (02/01/24)
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