- NavitsPartners (Boston, MA)
- Job Title: Travel - Registered Nurse ( RN ) - Case Management Location: Hyannis, MA Assignment Type: Travel Contract Duration: 13 Weeks Shift: Monday to Friday ... Total Weekly Compensation: $2,762 - $2,890 Position Overview: We are seeking an experienced Registered Nurse ( RN ) specializing in Case Management for a… more
- SUNSHINE ENTERPRISE USA LLC (Orange, CA)
- …of the position such as those listed above is also qualifying. Preferred Qualifications Active Registered Nurse ( RN ) license to practice in the state of ... Job Description Grievance & Appeals Nurse Specialist At Sunshine Enterprise...clinical issues. Managed care and health care industries. Appeals and grievance processes. At Sunshine Enterprise USA LLC,… more
- NYULMC (New York, NY)
- …Position Summary: We have an exciting opportunity to join our team as a Registered Nurse , Care Manager, Day Shift. In this role, the successful candidate ... News & World Report recently placed nine of its clinical specialties among the top five in the nation....Minimum Qualifications: To qualify you must have a Professional Registered Nurse in New York State with… more
- Beth Israel Lahey Health (Plymouth, MA)
- …to 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 cases… more
- Tenet Health (West Palm Beach, FL)
- …reporting of data for other departments. Qualifications EDUCATION Graduate of Registered Nurse Program EXPERIENCE 2 years acute care RN experience LICENSE ... discharge planning of all acute clinical areas. Responsible for all insurance authorizations, clinical communication, and denial and appeals . Tracking and… more
- NavitsPartners (Hyannis, MA)
- Job Title: Registered Nurse - Case Management (Travel) Location: Hyannis, MA Job Type: Contract Pay: $70 - $80.03/hour | $3,201/week (Travel Rate) Schedule: 40 ... Weekend | Rotating Holidays Job Overview We are seeking a highly skilled and motivated Registered Nurse - Case Manager (Travel) to join a dynamic care team in… more
- Vivo HealthStaff (Burbank, CA)
- …policies and influence process improvements. Qualifications: 1. Graduate from an accredited Registered Nursing Program; RN preferred. 2. Minimum of five years ... Job Description: Clinical Supervisor, UM Denial Compliance Location: Los Angeles...in prior-authorization, appeals & grievance, or health plan compliance. 3. Proven… 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 a… more
- UofL Health (Louisville, KY)
- …Health experience (required for positions at Peace Hospital) Licensure: *Active Kentucky Registered Nurse License or compact license with privileges to work ... serve through compassionate, innovative, patient-centered care. The Utilization Review RN performs activities which support the Utilization Management functions.… more
- University Hospitals (Beachwood, OH)
- …guidelines. (Required proficiency) CM software proficient. (Preferred proficiency) Licenses and Certifications Registered Nurse ( RN ), Ohio and/or Multi State ... reimbursement Perform timely and accurate review, denial communications and construct appeals , including remaining current with regulatory / payer and internal… more
- Jaz Staffing Agency (Houston, TX)
- …of Social Work program. Licenses/Certifications: Current and valid license to practice as a Registered Nurse in the state of Texas or Current and valid license ... Facilitates patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and… more
- Sigma, Inc. (Pittsburgh, PA)
- Job Title: Remote RN Case Manager - Contract (9464-1) | Pittsburgh, PA | Medicaid & Disease Management Location: Remote - Must reside in Pennsylvania Preferred: ... workforce solutions across healthcare and government sectors. We are currently hiring a Remote RN Case Manager to support our client in Pittsburgh, PA . This role… more
- CHPW (Seattle, WA)
- …license as an RN or LPN. Have at least two years clinical experience in either a physical health or behavioral health setting. Have previous experience ... of hospital notification or prior authorization care requests against established clinical guidelines and health plan policies. Collaborate with facilities to… more
- Kaiser Permanente (Denver, CO)
- …and procedures. Demonstrates quality and effectiveness in work habits and clinical practice in every interaction with patients, colleagues, providers, and ... review benefit exceptions, visiting member claims, self-funded claims reviews, appeals , to include verifying information, spreadsheet knowledge, locating the… more
- University of Iowa Hospitals & Clinics (Iowa City, IA)
- …Healthcare Downtown Campus, is looking for a Nurse Clinician to functions as a clinical nurse expert and clinical coordinator acting as nurse liaison ... by date of hire. 3 - 5 years of RN clinical nursing experience Excellent written and...Qualifications Professional Masters of Nursing and Healthcare Practice (MNHP), MSN/ Clinical Nurse Leader, or a Master's Degree… more
- Clarke County Hospital (Osceola, IA)
- …Preferred: Preferred Master's Degree in Nursing Experience: Preferred: Requires 5 years RN clinical hospital experience with minimum of 3 years management ... surgical services departments, staff development, front line staff orientation and nurse residency program that includes staff clinical competencies, standards… more
- Bryan Health (Lincoln, NE)
- …12. Ability to maintain regular and punctual attendance. EDUCATION AND EXPERIENCE: Current Registered Nurse licensure from the State of Nebraska or approved ... screening, insurance verification for benefits, medical necessity reviews, denial and appeals and coordinates admissions with the admitting physician and staff. Will… more
- Centene Corporation (Olympia, WA)
- …analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters ... for member and provider clinical appeals and ensure letters are compliant...assigned + Complies with all policies and standards **Education/Experience:** RN with 4+ years of clinical nursing… more
- R1 RCM (Boise, ID)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Supervisor** , you will help support clinicians ... position. **Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor...for additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position,… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound ... an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will...to assist with medical necessity determinations. Key Qualifications: + Registered Nurse with an active unrestricted professional… more
