- MedStar Health (Baltimore, MD)
- …and 1-2 years 2 years background/experience in hospital audits preferred Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact ... Candidates with previous Utilization Review or Denials /Appeals experience preferred General Summary of Position Responsible for coordinating and monitoring the… more
- UF Health (Gainesville, FL)
- …ensuring quality and regulatory compliance. Qualifications Minimum Education and Experience Qualification: Registered Nurse ( RN ) required or Internal Medical ... Overview The Clinical Documentation Integrity (CDI)/ Denials Manager is responsible for the strategic and...an assigned business purpose as a non-frequent driver. Licensure/Certification/Registration: Registered Nurse ( RN ) or Advanced… more
- Children's Mercy KC (Kansas City, MO)
- …Management, Utilization Review, and Performance Improvement Leadership One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri ... Nurse Case Managers, Social Workers, and Utilization Review specialist team members and support staff Analyzes, evaluates, and...required upon hire One of the following: Licensed RN - Kansas, Registered Nurse … more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials ... and tracks outcomes regarding appeal process. Assists billing staff regarding outpatient denials for experimental, coding or other issues that may require record… 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 ... opportunity employer. **Job Detail** **Job Opening ID** 266022 **Working Title** Denials Prevention/Appeals Specialist **Job Title** Medical Coder Compliance… more
- AdventHealth (La Grange, IL)
- …resolution skills . Teamwork principles **EDUCATION AND EXPERIENCE REQUIRED:** . Associates Degree Nursing or RN Diploma degree . Registered Nurse ( RN ) . ... **LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:** . State of Illinois registered nurse license **LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:**… more
- AdventHealth (Hinsdale, IL)
- …for Discharge Planning + Conflict management and resolution skills + Teamwork principles + Registered Nurse ( RN ) Required + Certified Case Manager (CCM) ... 120 N OAK ST, Hinsdale, 60521 **The role youll contribute:** The RN Care Manager in collaboration with the patient/family, social workers, nurses, physicians… 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...along to healthcare insurance providers in response to post-claim denials received by BMHCC. Physician Advisor communication may be… more
- St. Luke's University Health Network (Allentown, PA)
- …Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. . ... a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews...and procedure code assignment and MS-DRG/APR-DRG accuracy based on denials or audit findings from government and commercial payers.… more
- HonorHealth (AZ)
- …1 year experience in UR/UM or Case Management Required Licenses and Certifications Registered Nurse ( RN ) State And/Or Compact State Licensure Required ... more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of...from an accredited NLN/CCNE institution Required Experience 3 years Registered Nurse in an acute care setting.… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. ... molecular pathology, high-cost drug, and off-label drug authorizations. The Clinical Authorization Specialist is also responsible for managing denials related to… more
- UPMC (Pittsburgh, PA)
- … Health Information Administrator OR Registered Health Information Technician (RHIT) OR Registered Nurse ( RN ) + Act 34 *Current licensure either in ... UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within our... (CCS) OR Certified Professional Coder (CPC) OR Certified Registered Nurse Practitioner OR Doctor of Medicine… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Clinical Documentation Integrity Specialist Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the region's ... be named a Forbes "Best Employer" seven times. Position Summary: The CDI Specialist serves as liaison between the physicians and hospital departments to promote… 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
- 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...initial and ongoing authorizations, monitor payer-specific requirements, and resolve denials and claim issues to ensure timely access to… more
- St. Mary's Healthcare (Amsterdam, NY)
- …Improvement Specialists obtained prior to hire date or job transfer date. * Registered Nurse credentialed from the New York Board of Nursing obtained ... and coding to maximize documentation, ensure compliance and reduce denials * Works with case management and the admit...One or more of the following: * Certified Coding Specialist (CCS) credentialed from the American Health Information Management… more
- Hartford HealthCare (Farmington, CT)
- …Business Office in Newington. *_Position Summary:_* The Revenue Integrity Specialist determines the appropriateness of patient charges, and Charge Description ... and completeness, following regulatory requirements, in order to resolve edits, denials or exceptions detected during system processing of the claim. *_Position… more
- Penn Medicine (Philadelphia, PA)
- …8a-4:30p, Remote The Health Information Management (HIM) Clinical Documentation Specialist will oversee organization-wide system for improving clinical documentation ... departmental and health system quality initiatives. Process clinical validation denials by disputing payer payment reductions when appropriate through identification… more
- Catholic Health Initiatives (Omaha, NE)
- …Commonspirit Health Facility Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact patient care and optimize ... experience.** Medical Coding experience is a plus! As our Utilization Review RN , you will be responsible for conducting comprehensive reviews of medical records… more
- Nuvance Health (Danbury, CT)
- …Review experience(or a certification ACMA, MCG, Interqual) Required : CT Registered Nurse License Working Conditions: Manual: significant manual skills/motor ... rotate one weekend per month Summary: The purpose of the Utilization Management Nurse is to support the physician, the interdisciplinary team, and organization with… more
