- SUNSHINE ENTERPRISE USA LLC (Orange, CA)
- Job Description Grievance & Appeals Nurse Specialist At Sunshine Enterprise USA, we're not just a company; we're a community of dedicated professionals ... our current job opportunities below. Job Title: Grievance & Appeals Nurse Specialist Department(s): Grievance...those listed above is also qualifying. Preferred Qualifications Active Registered Nurse ( RN ) license to… more
- NavitsPartners (Worcester, MA)
- Job Title: Travel RN - Case Management Specialist Location: Hyannis, MA Assignment Type: Travel Contract Duration: 13 Weeks Shift: Monday to Friday | 8:00 AM - ... 4:30 PM Weekly Compensation: $2,762 - $2,890 Overview: Seeking a skilled Travel RN with expertise in case management to support patient-centered care coordination in… more
- University of Michigan (Ann Arbor, MI)
- Denials Prevention/ Appeals Specialist Apply Now **Job Summary** The Denials Prevention and Appeals Specialist is responsible for ensuring the accuracy ... employer. **Job Detail** **Job Opening ID** 266022 **Working Title** Denials Prevention/ Appeals Specialist **Job Title** Medical Coder Compliance Spec **Work… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
- LifePoint Health (Hickory, NC)
- * Registered Nurse ( RN ), Clinical Case...the lives of those we serve.** *Connect with our RN recruiting specialist * Not ready to complete an ... valued as an employee, but as a person. As a* registered nurse ( RN )*joining our team,...payer guidelines and discharge financial implications. * Manages denial appeals and chart audit reviews. *7. Case Management** Acts… more
- Molina Healthcare (Midvale, UT)
- **JOB DESCRIPTION** _For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state of UTAH or have a compact license._ _This ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of… 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
- State of Colorado (Sterling, CO)
- CDOC Registered Nurse - Part-time - Sterling Print...Yes + No 06 Do you possess an active RN license issued by an Enhanced Nurse Licensure ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4992041) Apply CDOC Registered Nurse - Part-time - Sterling Salary...Colorado? If so, what state issued your license? 07 Nurse Licensure Compact: If appointed to an RN… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA and other...+ Communicate and work collaboratively with AG Representatives, Resolution Specialist and Management to maintain and improve quality of… more
- Baptist Memorial (Memphis, TN)
- Overview Specialist -Denial Mitigation II RN Job Code: 21432 FLSA Status Job Family: FINANCE Job Summary * Position may be filled in Memphis, TN; Jackson , MS The ... Denial Mitigation-Appeal Specialist II RN serves in a key...maximize customer satisfaction. + Submits retro-authorization requests, reconsiderations, and appeals with careful regard to payer specific timeframes, contractual… more
- Trinity Health (Des Moines, IA)
- …72 hours biweekly Day Shift **General Requirements:** + Iowa licensure as a Registered Nurse . + Member of a professional healthcare organization. **Education:** ... the MercyOne Family! We are looking to hire a RN Clinical Integration Specialist . The purpose of...and Medicaid Services (CMS), Iowa Department of Inspections and Appeals (IDIA), The Joint Commission (TJC),etc.), in conjunction with… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks ... preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending....an accredited, professional nursing program. + Must have current RN license to practice in the state of Pennsylvania… more
- State of Michigan (Lansing, MI)
- …Psychologist (LLP); Fully Licensed Psychologist (LP); Licensed Master Social Worker (LMSW); Registered Nurse ( RN ); Licensed Professional Counselor (LPC) + ... Departmental Specialist 13 - Specialized Nursing Home OBRA Program.... Reviews, coordinates and represents the Department on statewide appeals of preadmission screenings/annual resident reviews Medicaid recoveries before… more
- City and County of San Francisco (San Francisco, CA)
- …and Certification: + Registered Nurse License: Possession of a valid California Registered Nurse ( RN ) license issued by the California Board of ... Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a valid...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- City and County of San Francisco (San Francisco, CA)
- …and Certification: + Registered Nurse License: Possession of a valid California Registered Nurse ( RN ) license issued by the California Board of ... Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a valid...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. ... Working in a fast-paced, high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and … more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Therapy and/or Prior Authorization experience is preferred. + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. **KNOWLEDGE, SKILLS, ... The Cell Therapy Clinical Authorization Specialist is responsible for the comprehensive coordination and management of all prior authorization activities specific to… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to… more
- Independent Health (Buffalo, NY)
- … Health Information Technician (RHIT), Certified Clinical Documentation Specialist (CCDS), American Health Information Management Association (CCS-H, CCS-P), ... growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist -Senior will be responsible for reviewing coding and clinical...Certification Denials and Appeals Management (C-DAM), or NYS licensed RN … more
