- MVP Health Care (Schenectady, NY)
- …requires innovative thinking and continuous improvement. To achieve this, we're looking for a ** Professional , Clinical Appeals RN ** to join #TeamMVP. ... in New York.** **Qualifications you'll bring:** + Active, unrestricted RN license in good standing + Graduate of an...and clinical guidelines. + Previous experience in clinical appeals , utilization management or managed care… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse ( RN ) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & ... + Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and… more
- Molina Healthcare (Salt Lake City, UT)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal appeals clinical processes - ensuring that ... health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… more
- State of Colorado (Denver, CO)
- …III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5120373) Apply Registered Nurse Health Compliance Inspector, Nursing ... Registered Nurse Health Compliance Inspector, Nursing...not be considered. If you are a current HFEMS RN Health Compliance Inspector (Health Professional III);… more
- Walgreens (Deerfield, IL)
- …for customers, patients, team members and communities. **Job ID:** 1655228BR **Title:** Registered Nurse ( RN ) Specialty **Company Indicator:** Walgreens ... care modules or standard operation procedures approved by the Clinical and Professional Services Team including scripting,...Associate's degree in Nursing + Current license/registration as an RN ( Registered Nurse ) with the… 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
- Sacramento County (Sacramento, CA)
- …In a detention/correctional facility, the Registered Nurse D/CF performs a variety of professional ... records. Examples of Knowledge and Abilities Knowledge of + Professional registered nursing principles, procedures and techniques...02 Select the one box that best describes your Registered Nurse ( RN ) license issued… 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
- CareFirst (Baltimore, MD)
- …strategies to improve individual and team-based performance as needed. **Licenses/Certifications** : + RN - Registered Nurse - State Licensure And/or Compact ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates...all applicable External review rights. Acts as the primary professional resource to internal and external stakeholders with the… more
- Commonwealth Care Alliance (Boston, MA)
- …complexities that require intensive care management and care delivery. Within the CIC Program, the Registered Nurse ( RN ) serves as an integral member of an ... and addresses significant medical, behavioral, and social needs. The RN uses evidenced-based care approaches, clinical skills,...including: + 5+ years' experience as Registered Nurse in a high touch clinical environment… more
- State of Colorado (Pueblo, CO)
- Nurse I - Registered Nurse I -...of patient care and is coordinated across a continuum. The Nurse I adheres to and references the professional codes ... CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5130579) Apply Nurse I - Registered Nurse I - CMHHIP Salary $43.80 - $61.31… more
- State of Colorado (Pueblo, CO)
- Registered Nurse II- CMHHIP Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5130585) Apply Registered Nurse II- CMHHIP Salary ... listed. + Description + Benefits + Questions Department Information Registered Nurse II-Full Time CMHHIP This posting...patient care and is coordinated across a continuum. The Nurse II adheres to and references the professional… more
- State of Colorado (Denver, CO)
- Registered Nurse I-Colorado Mental Health Hospital in Fort Logan-Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5078182) Apply ... Registered Nurse I-Colorado Mental Health Hospital in...During specific shifts, functions in the role of Charge Nurse and provides clinical and administrative supervision… more
- Centene Corporation (Salem, OR)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... report verbal and written information regarding member and provider clinical appeals , including information follow up +...assigned + Complies with all policies and standards **Education/Experience:** RN with 4+ years of clinical nursing… more
- CommonSpirit Health (Westminster, CO)
- …excellence and achieve professional fulfillment united in humankindness. As a Registered Nurse ( RN ) you will assume responsibility and accountability ... external applicants with at least six months of direct RN experience are eligible for a $20,000 sign-on bonus!**...care for orthopedic, abdominal, and general surgeries. 5 West appeals to anyone interested in broadening their skillset as… more
- BronxCare Health System (Bronx, NY)
- …by the department physician advisors and clinical staff. Qualifications - NYS Registered Nurse required - The Appeal Manager must have excellent verbal and ... and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical ...preferred. -The Appeal Manager should have experience as a nurse in acute care clinical setting who… more
- Beth Israel Lahey Health (Cambridge, MA)
- …high reliability processes to reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, ... skills to prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for medical peer review.… more
- Centene Corporation (New York, NY)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... appeals and grievances from a clinical perspective. Ensure that the clinical Appeals and Grievance department processes all cases in accordance with… more
- Beth Israel Lahey Health (Plymouth, MA)
- …establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical ... team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding… more
- WMCHealth (Valhalla, NY)
- …or continued stay, when necessary. + Secures physician input for insurance appeals when necessary. + Incorporates knowledge of clinical expertise, quality, ... Denials and Appeals Mngmt Cord Company: WMC Advanced Physician Services...policies and procedures. + Incorporates the highest standard of professional , clinical , legal, and ethical practice (ie,… more