- Sourcing Square US (Philadelphia, PA)
- …to be paid. RESPONSIBILITIES/ACCOUNTABILITIES:Reviews patient medical records; utilize clinical , regulatory knowledge and skills to provide convincing appeal ... be in breach of published regulations or payer policy guidelines.Uses clinical evidence and/or regulatory arguments to prove appeal reasoning.Participates in… more
- University of Washington (Seattle, WA)
- …**UW MEDICINE'S PATIENT FINANCIAL SERVICES Department** has an outstanding opportunity for a ** CLINICAL APPEALS AND DISPUTES NURSE ** **Work Schedule** + 100% ... communicated payer decisions in a timely manner + Review clinical denials and initiate appeals process +...**REQUIREMENTS** + Active licensure to practice as a Registered Nurse in Washington State + Bachelor's degree in Nursing… more
- Elevance Health (Rancho Cordova, CA)
- ** Nurse Appeals - Licensed RN Nurse.../grievances/quality of care issues and is a resource for clinical and non clinical team members in expediting ... **Shift:** Monday to Friday from 8:00-5:00 pm PT The ** Nurse Appeals ** is responsible for investigating and...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- LA Care Health Plan (Los Angeles, CA)
- …the needs of LA Care's culturally diverse membership. The position supports the A&G Clinical Manager . This role also assists the A&G Leadership in identification ... Supervisor, Appeals and Grievances Clinical Operations RN...Must be able to work independently. Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California License… more
- VNS Health (Manhattan, NY)
- …Will Do + Responsible for direct oversight and the day to day management of clinical appeals review processes within Appeals & Grievances Department. + ... to, Provider Relations, Claims, Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and grievances. + Ensures… more
- Genesis Healthcare (Philadelphia, PA)
- …to be paid. RESPONSIBILITIES/ACCOUNTABILITIES: Reviews patient medical records; utilize clinical , regulatory knowledge and skills to provide convincing appeal ... be in breach of published regulations or payer policy guidelines.Uses clinical evidence and/or regulatory arguments to prove appeal reasoning.Participates in… more
- Sharecare, Inc. (Columbus, OH)
- …or assist member in working with payer to complete prior authorization or appeals process, when necessary. + Abide by Clinical Advocacy Program Description ... leadership for each year. + Direct questions from providers or members to the Clinical Advocate Manager or Director when he/she identifies an opportunity for… more
- The Mount Sinai Health System (New York, NY)
- …communication and monitoring of discharge planning process in collaboration with the clinical nurse initiates the discharge planning process on admission. * ... timely basis and identify the expected length of stay (ELOS). The case manager works collaboratively with physicians, social workers, clinical nurses, home care… more
- Glens Falls Hospital (Glens Falls, NY)
- …Managers, RNs, and Patient Service Staff, this role is for you! *Team Impact* As the Clinical Nurse Manager , you will provide overall clinical and ... with leadership experience to join as our next Nurse Manager ! This opportunity will open a...CCI edits, and charge review . Serve as a clinical resource for appeals and denials .… more
- Trinity Health (Syracuse, NY)
- …appropriate discharge plan for the patients within their service area. The Registered Nurse Manager is accountable for applying positive managerial strategies to ... by the St. Joseph's Health Mission and Values, the manager of Utilization Review is responsible for the planning,...of health care resources via pre- and post-service review, appeals and program and network referrals. The scope of… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …single largest account Position Summary: The RN Clinical Provider Post Service Review Manager , led by a Registered Nurse , is responsible for a team of ... a member and provider call center, provider correspondence and appeals , clinical review, member correspondence and reconsiderations,...perform claim adjustments in a dual system environment. This manager also has direct oversight to a team of… more
- State of Colorado (Denver, CO)
- …+ Less than one year of experience 09 How many years of experience do you have as Nurse Manager , or Clinical Supervisor? + 2 or more years of experience + ... clinic operations + Respond to case escalations + Provide clinical coverage as needed + Review and approve the...license number. 02 Please describe your experience as a Nurse Manager and how you have been… more
- State of Colorado (Denver, CO)
- …and level of staffing during own shift and proximal shifts. In collaboration with Nurse Manager and treatment team, recommends a change in program scheduling to ... During specific shifts, functions in the role of Charge Nurse and provides clinical and administrative supervision...coaching and direction in the moment, and recommends to Nurse Manager strategies to improve staff skills… more
- State of Colorado (CO)
- …CAA Nurse III 2/2024 Department Department of Corrections Division Clinical and Correctional Services Opening Date 02/08/2024 Closing Date 12/31/2024 4:00 PM ... CDOC Nurse Supervisor Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4383689) Apply CDOC Nurse Supervisor Salary $8,204.00 - $11,487.00… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4555045) Apply CDOC Registered Nurse ( Nurse I) ... $7,442.00 Monthly Location Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 7/2024 Department Department of Corrections Division Clinical and… more
- International Medical Group (Indianapolis, IN)
- …status (eg, H-1B or TN status) for this position. JOB SUMMARY The Case Manager will evaluate medical necessity, appropriateness, and efficiency of the use of health ... outpatient management of assistance cases. + Knowledge of the Non-certification process and Appeals process including logs and time frames. + Participate in the on… more
- The Mount Sinai Health System (New York, NY)
- …education to Case Managers and other hospital personnel as needed. The Nursing Clinical Manager collaborates with Appeals Management, Managed Care ... **JOB DESCRIPTION** **The Nursing Clinical Manager (NCM) for Case Management...Nursing Department meetings. + Works with unit case managers, clinical nurse managers, physicians, and social workers… more
- BlueCross BlueShield of Tennessee (UT)
- …retrospective claim review, special review requests, and UM pre\-certifications and appeals , utilizing medical appropriateness criteria, clinical judgement, and ... for other internal positions\. **Job Qualifications** _License_ + Registered Nurse \(RN\) with active license in the state of...Health division at BCBST is looking to add a Clinical Review Manager to our team\. Preference… more
- Point32Health (MA)
- …click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Clinical Program Manager is a Registered Nurse who performs program oversight activities ... effective working relationships across partnering business areas and external entities. The Clinical Program Manager is a highly motivated individual with an… more
- The Mount Sinai Health System (New York, NY)
- …education to Case Managers and other hospital personnel as needed. The Nursing Clinical Manager collaborates with Appeals Management, Managed Care ... **JOB DESCRIPTION** The Nursing Clinical Manager (NCM) for Case Management...Nursing Department meetings. 5. Works with unit case managers, clinical nurse managers, physicians, and social work… more
