- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- CommonSpirit Health (Centennial, CO)
- …to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for ... will need the following: Required Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with… more
- Mayo Clinic (Rochester, MN)
- …well as preparation of relevant appeal submission or audit responses. Utilizes clinical expertise and critical thinking in the evaluation of medical records against ... Experience: 3 years of relevant nursing experience Current active unrestricted RN license. The preferred applicant will have the following experience: Advanced… more
- Nuvance Health (Danbury, CT)
- …Days, Evenings, Nights available* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within ... in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- Nuvance Health (Danbury, CT)
- …Hours 5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, ... to inquiries and facilitates communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and appeal… more
- McLaren Health Care (Mount Pleasant, MI)
- …the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and achieve optimal ... other related duties as required and directed. **Qualifications:** **_Required:_** + Registered Health Information Technician (RHIT), Licensed Practical Nurse … more
- Intermountain Health (Montgomery, AL)
- **Job Description:** The RCO Appeals Specialist is responsible for researching and appealing denied medical claims. Responsible to proactively identify insurance ... Advisor and works with them to obtain support for appeals . + Collaborates with Care Management, Physician Advisors, Revenue...expert, resource and mentor to others within the RCO, clinical departments, Appeal RN 's, legal, IPAS and… more
- Beth Israel Lahey Health (Cambridge, MA)
- …to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality data by ... on the key performance indicators and quality measures, the RN specialist also aims to foster a...reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review… 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/5123731) Apply CDOC Registered Nurse ( Nurse I) Salary $7,591.00 - $10,627.00 Monthly… more
- Cedars-Sinai (Beverly Hills, CA)
- …Angeles Fair Chance Initiative for Hiring. **Req ID** : 12949 **Working Title** : Registered Nurse - ISP Care Coordinator - PER_DIEM 8 Hour Days **Department** ... care. Use Milliman and Interqual guidelines as necessary. + Collaborates with clinical teams and practices to ensure synchronization of sub-areas' operations to… more
- Houston Methodist (Sugar Land, TX)
- …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... review, case management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of… 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 Remote PRN Clinical Utilization Review Specialist is responsible...conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate… more
- Hartford HealthCare (Farmington, CT)
- …management and appeals preferred. **Licensure, Certification, Registration** * Active Registered Nurse license from the State of Connecticut * Certified ... and submit appeals for DRG denials, ensuring appeals are well-supported with clinical evidence, coding... Clinical Documentation Specialist (CCDS), Certified Documentation Integrity… more
- University of Southern California (Arcadia, CA)
- …requirements impact DRG assignments. + Minimum of three years' experience in clinical disciplines ( RN , MD, FMG) or utilization review/case management in ... Documentation Improvement Practitioner (CDIP) certification status preferred. + Certified Clinical Documentation Specialist (CCDS) credential preferred. Pay… more
- Molina Healthcare (NE)
- …will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have ... and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted… more
- CaroMont Health (Gastonia, NC)
- …denial activity and appeal results. Maintains the Status Change Database. Performs retrospective clinical reviews/ appeals as part of denial process. The UR ... duties as assigned. Qualifications: Bachelor's degree from an accredited college with a clinical background. BSN required. Current RN license to practice in NC… more
- BriteLife Recovery (Englewood, NJ)
- …clinical information and advocating for appropriate levels of care. The UR Specialist works closely with clinical staff, admissions, medical providers, and ... What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible for… more
- SUNY Upstate Medical University (Syracuse, NY)
- …preparing regulatory notices for delivery to the patient Minimum Qualifications: NYS Licensed/ Registered (or eligible) RN , Bachelor's Degree in Nursing, and a ... Job Summary: The UR-CR Specialist I is primarily responsible for ensuring that...minimum of three years post RN licensure acute care nursing experience, or Associate's Degree… more
- UnityPoint Health (Cedar Rapids, IA)
- …This position is on site at St. Luke's Hospital. The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments serves a key role in ... utilization of health care resources, provision of high-quality health care, optimal clinical outcomes and patient and provider satisfaction. The UM Specialist … more
- UNC Health Care (Kinston, NC)
- …accredited school of nursing, BSN preferred. + **EXPERIENCE** + Minimum 3-5 years of applied clinical experience as a Registered Nurse required. + 2 years ... denials management preferred. + **LICENSURE/REGISTRATION/CERTIFICATION** + Licensed to practice as a Registered Nurse in the state of North Carolina. **Job… more