- Morningstar Living (Nazareth, PA)
- …maintain current RN licensure by the Pennsylvania State Board of Nurse Examiners. Two (2) years of RNAC or related experience preferred. RAC-CT certification ... Morningstar Living is currently hiring a per diem RN Resident Assessment Coordinator (RNAC) for our Health...HMO reimbursement issues. Responsible for the managed Medicare products, appeals and submission of weekly documentation. What do I… more
- Strategic Staffing Solutions (Burlington, VT)
- …with one of our largest clients located in Vermont! Title: Clinical Review Registered Nurse Duration : W2 Contract Location: Remote in Vermont Duration: ... for review.' Required experience: Must have 5+ years of clinical/hospital experience as a RN Must have a Compact Nursing License. Must bring 2+ years of Utilization… more
- Boston Childrens Hospital (Boston, MA)
- …and or Utilization Management) preferred. Licensure/ Certifications: Current Massachusetts license as a Registered Nurse ( RN ) A certification as a Certified ... for the appropriate level of care for admissions and with post-discharge appeals of payer denials. They identify and implement initiatives to manage utilization… more
- Children's Health (Dallas, TX)
- …practice of professional nursing; * Other job duties as assigned Credentials: Essential: * Registered Nurse Other information: WORK EXPERIENCE * At least 5 years ... Job Title & Specialty Area: Prospective Review RN Department: Utilization Management Location: Dallas Shift: Day...degree or equivalent experience Pref LICENSES AND CERTIFICATIONS * Registered Nurse Req * Accredited Case Manager… more
- Mount Sinai Hospital (New York, NY)
- …clinical nurse . Licensing and Certification Requirements (if applicable) License: RN (current) and Certification Issuing Agency: NYS/ Department of state Name: ... hospital personnel as needed. The Nursing Clinical Manager collaborates with Appeals Management, Managed Care Contracting and other institutional departments to… more
- VCU Health (South Hill, VA)
- …and outcome oriented. Licensure, Certification, or Registration Requirements for Hire: Licensed Registered Nurse in the State of Virginia or eligible Licensure, ... by August 31, 2025. Terms and Conditions apply** The RN Care Coordinator functions as a part of a...and setting of care, assists in the denial and appeals process, assesses quality and identifies and reports potential… more
- Healthier Mississippi People (Jackson, MS)
- …per case, excess days, resource utilization, readmission rates, denials and appeals . Uses data to drive decisions and plan/implement performance improvement ... 20%, frequent-from 21% to 50%, constant-51% or more) Requirements Must be licensed as RN and have at least one (1) year acute care experience. Utilization management… more
- Memorial Hermann Health System (Pearland, TX)
- …Social Work program L icenses/Certifications : Current and valid license to practice as a Registered Nurse in the state of Texas or Current and valid license as ... per case, excess days, resource utilization, readmission rates, denials and appeals . Uses data to drive decisions and plan/implement performance improvement… more
- Athens Health and Rehabilitation LLC (Huntsville, AL)
- …in accordance with the assessment and the plan of care. QUALIFICATIONS Must be a Registered Nurse in good standing in the state(s) in which assigned RAC ... of Medicare and Rehabilitation in gathering information for Medicare and Medicaid appeals and denials as requested. During facility visits, conducts an exit… more
- UHS (Riverside, CA)
- … Nurse certificate from an accredited Nursing Program in California. Registered Nurse ( RN ) preferred/desired. ESSENTIAL FUNCTIONS: Essential functions ... Responsibilities SUMMARY: The Delegation Oversight Nurse performs activities to assure compliance with Health Plan requirements. The Nurse will manage activities… more
- CentraState Healthcare System (Freehold, NJ)
- Overview Emergency Department (ED) Nurse Care Manager is responsible for establishing, coordinating, and maintaining the process to optimize patient throughput to ... facilitating interdisciplinary care across the continuum for the ED. The Nurse Care Manager collaborates with the patient/family, multidisciplinary team, physicians,… more
- NYULMC (Brooklyn, NY)
- …and status information. Refers questions related to prescription information to RN /LPN/Provider. Initiates and follows-up on pre-authorizations and appeals and ... legibly and accurately. Forwards areas requiring clinical information to LPN, RN or Licensed Provider. Secures appropriate signatures and forwards documents/forms to… more
- Northwell Health (Staten Island, NY)
- …retro clinical reviews and triages each case to next appropriate facilitator (ie Appeals RN , Physician Advisor, etc.). * Facilitates processing of managed care ... denials: Generates, prints and distributes denial documentation. Enters required information into department computer system. Communicates denial status to appropriate Case Manager. Collects appeal documentation from clinical team members and distributes to… more
- Northwell Health (Staten Island, NY)
- …retro clinical reviews and triages each case to next appropriate facilitator (ie Appeals RN , Physician Advisor, etc.). Facilitates processing of managed care ... denials: Generates, prints and distributes denial documentation. Enters required information into department computer system. Communicates denial status to appropriate Case Manager. Collects appeal documentation from clinical team members and distributes to… more
- Children's Hospital & Medical Center (Omaha, NE)
- …may be considered. Children's Nebraska has an exciting opportunity to join our Nurse Practitioner Critical Care Transport team! Our Pediatric Nurse Practitioners ... helicopter and a Pilatus PC-12 fixed-wing aircraft. The Pediatric Nurse Practitioner Transport Provider is responsible for managing the...activities and is home to a world-class zoo that appeals to children and adults alike. Greater Omaha has… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …more **Description** We're seeking under the direction of the **Utilization Management Appeals Professional, Registered Nurse ** is responsible for managing ... **MINIMUM QUALIFICATIONS** : + License - Must have a valid, active unencumbered Registered Nurse license or temporary permit approved by the Georgia Licensing… more
- Intermountain Health (West Valley City, UT)
- …medical necessity of the admission. Reports to the Director of Audit and Appeals in the Revenue Integrity Department. ESSENTIAL DUTIES AND RESPONSIBILITIES 1. Uses ... write up clinical reviews for insurance audits and governmental insurance appeals using supporting documentation. 2. Assesses the appropriateness of clinical appeal… more
- State of Colorado (Denver, CO)
- …(HP III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5019261) Apply Registered Nurse Health Compliance Inspector Home Care - ... Registered Nurse Health Compliance Inspector Home Care -...FAA00094 (HP III RN ) Salary $80,916.00 Annually Location Denver, CO Job Type Full Time… more
- State of Colorado (Denver, CO)
- …(HP III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5010527) Apply Registered Nurse , Complaints Health Compliance Inspector - ... Registered Nurse , Complaints Health Compliance Inspector -...FAA00438 (HP III RN ) Salary $80,916.00 - $90,648.00 Annually Location Denver, CO Job… more
- State of Colorado (Golden, CO)
- Registered Nurse I, RN I...of the department's action. For more information about the appeals process, the official appeal form, and how to deliver ... Mountain, Youth Services Center - Golden Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5019028) Apply Registered Nurse I, RN I -… more