- St. Luke's University Health Network (Allentown, PA)
- …a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... meetings with auditor or payor representatives in defense of coding appeals , as needed. Maintain necessary audit/appeal activity documents including Excel… more
- MLee Healthcare Staffing and Recruiting, Inc (Omaha, NE)
- …good schooling, and year-round community-based activities are among the many appeals to this position. Requirement: Registered Nurse current licensure ... Registered Nurse - Cardiac Cath Lab (RN) Are you seeking an environment that fosters both your personal and professional development? Look no further. This location… more
- Regal Medical Group, Inc. (West Covina, CA)
- Position Summary: The Quality Improvement Nurse reports to the VP and Director of QI and carries out the day-to-day activities related to ensuring compliance to QI ... QI Department Director. The role of the QI Team Nurse is to promote and support the quality and...as an intra-team contact for staff for questions on appeals and grievances and offers assistance as may be… more
- Stony Brook University (Stony Brook, NY)
- …Perform minor joint procedures. Work with clinic staff together for insurance appeals and pre-authorizations as necessary. Coordination with clinic staff of patient ... as assigned by the Division Chief or designee. Qualifications Required Qualifications: NURSE PRACTITIONER: NYS license and certification as a Nurse Practitioner.… more
- MLee Healthcare Staffing and Recruiting, Inc (Omaha, NE)
- Travel Wound Care (RN) Registered Nurse - Up to $70 An Hour 13-week contract* We are seeking a highly motivated and compassionate (Wound Care) Registered Nurse ... good schooling, and year-round community-based activities are among the many appeals to this position. Qualifications: Associates degree in nursing, Bachelor of… more
- Luminis Health (Lanham, MD)
- …and administrative personnel for unresolved issues; identifies opportunities for expedited appeals and collaborates with the care coordinator and Physician Advisor ... to resolve payer issues. 4. Process improvement initiatives Participates in nursing unit and department clinical outcome projects as well as process improvement initiatives of care management. Educational/Experience Requirements: Bachelor's of Science in… more
- MLee Healthcare Staffing and Recruiting, Inc (Redfield, IA)
- Registered Nurse - RN Full-Time / Generous Benefits / Sign-on Bonus We are seeking a highly motivated and compassionate Registered Nurse to join our growing team ... schooling, and year-round community-based activities are among the many appeals to this position. Qualifications: 1 year of clinical...1 year of clinical nursing experience as a Registered Nurse (RN) Associate degree in nursing (ADN) from an… more
- CNY Family Care LLP (Syracuse, NY)
- …met for medication approval. Secure prior authorizations for medications and complete appeals for medically necessary medications when authorization is denied by the ... to the insurance company for medications. Follow up on requests or appeals as needed. Communicate with providers on formulary or more cost-effective alternatives.… more
- HealthKeeperz, Inc. (Wilmington, NC)
- …Persons (LRP) about care teams, services, rights, the grievance and appeals process, available service options, and payer requirements. *Promote customer ... nursing or another relevant human services area, or licensure as a registered nurse (RN) *Two years of experience working directly with individuals with behavioral… more
- FloodGate Medical (Tampa, FL)
- …and facilities regarding the coding, billing, prior authorization process, and appeals process for Sonex Health products. Communicate and collaborate with staff ... access personnel at accounts (eg, Surgery Schedulers, Billers, Case Managers, Nurse Coordinators, etc.) Educate healthcare providers and their staff on Market… more
- Mount Sinai Hospital (New York, NY)
- …hospital personnel as needed. The Nursing Clinical Manager collaborates with Appeals Management, Managed Care Contracting and other institutional departments to ... monthly Nursing Department meetings. 5. Works with unit case managers, clinical nurse managers, physicians, and social work to facilitate Interdisciplinary Rounds to… more
- Heywood Hospital (Gardner, MA)
- …and department policies. Report any variances, trends to director. Submits denials/ appeals when completed to the department secretary for processing. Discharge ... Industry preferred Minimum License and Certifications Current Massachusetts Registered Nurse License Required Skills Interqual experience or equivalent preferred… more
- Trinity Health (Berwyn, IL)
- …Description: The Lead Case Manager position reports to the Manager of Nurse Care Management. Their specific duties include: Recruiting, interviewing, hiring, and ... reporting of financial indicators including care readmission rates, denial and appeals . Use data to drive decisions and plan/implement performance improvement… more
- University of Southern California (Los Angeles, CA)
- …follows hospital procedures for accurate and timely processing of charges. Appeals Management: Develop and implements standards and processes for the formulation ... healthcare management software and data analysis tools. Required Licenses/Certifications: Req Registered Nurse - RN (CA Board of Registered Nursing) Req Basic Life… more
- Veterans Care Centers of Oregon (Lebanon, OR)
- LPN Charge Nurse Wages DOE: $31.20 - $39.75 NOC Shift (6pm-6am) $2.00/hour differential when working between 10pm and 6am $3,000 Sign on Bonus for LPNs! 12 hour ... New grads encouraged to apply! OVHL has a great Nurse Mentoring Program to help you be supported and...*Current CPR and First Aid certification required. If this appeals to you contact Cheryl Walter, DNS at ###… more
- Central Health (Austin, TX)
- …the most appropriate course of treatment and may also be involved in the appeals process when necessary. In this role, the Utilization Management nurse play ... to three years of nursing experience in an inpatient setting or case management- Required Licenses and Certifications: Registered Nurse License in the State of Texas more
- Clarke County Hospital (Osceola, IA)
- …surgical services departments, staff development, front line staff orientation and nurse residency program that includes staff clinical competencies, standards of ... including but not limited to DNV, Department of Inspections and Appeals Critical Access Hospital Regulations, professional nursing standards of care/practice and… more
- VCU Health (South Hill, VA)
- …oriented. Licensure, Certification, or Registration Requirements for Hire: Licensed Registered Nurse in the State of Virginia or eligible Licensure, Certification, ... of level and setting of care, assists in the denial and appeals process, assesses quality and identifies and reports potential risk management issues.… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound clinical judgement to ... timeframes.The TeamAs an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a liaison and business expert for member and… more
- R1 RCM (Boise, ID)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Nurse ** , you will help our hospital clients by ... production-driven position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical records and… more
