- Houston Methodist Specialty Physician Group (Webster, TX)
- …assigned patient population, under the direct supervision of a Physician, APP and/or Registered Nurse . This position oversees appropriate scope of practice, (ie ... patients visiting the clinic under the direct supervision of a Physician, Registered Nurse , or clinic leadership procedures. Complete pre-visit planning workflow… more
- Baptist Memorial Health (Memphis, TN)
- …Review Facility: BMHCC Corporate Office Department: HS Case Mgmt Administration Corporate Category: Nurse RN Type: Clinical Work Type: PRN Work Schedule: Days ... Summary The Utilization Review Nurse is responsible for evaluating the medical necessity and appropriateness of healthcare services and treatment as prescribed by… more
- MVP Health Care (Tarrytown, NY)
- …you'll bring: Current New York State Licensure as a Registered Nurse required. Certification in Case Management required within 24 months after ... At least 3 years of recent clinical and Case Management experience. Experience working in a Medicaid Long Term...cost-effectiveness and manage Medical Loss Ratio (MLR). Appeals & Denials : Participate in the appeals process for denied services… more
- Houston Methodist (Sugar Land, TX)
- …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical… more
- UNC Health Care (Kinston, NC)
- …preferred. + **EXPERIENCE** + Minimum 3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review, care management , ... or compliance experience preferred. + Minimum 1 year clinical denials management preferred. + **LICENSURE/REGISTRATION/CERTIFICATION** + Licensed to practice as… more
- Nuvance Health (Danbury, CT)
- …and trending all appeals and communicating on a daily/regular basis with the Denials Management team. * Assists with informing Managed Care contracting team ... This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to...required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting… more
- Nuvance Health (Danbury, CT)
- …in nursing, health administration, or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience ... and strategy for system-wide care coordination, encompassing utilization review (UR), denials management , discharge planning, social work, and non-clinical… more
- Houston Methodist (Houston, TX)
- …leading multi-site or enterprise-level programs preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... exposure to confidential/sensitive information + Proven expertise in throughput optimization, denials management , and team leadership across diverse care… more
- HealthTrust Workforce Solutions (Bradenton, FL)
- …access to more than 200,000 jobs nationwide. **_JOB SUMMARY_** The Interim Leader of Case Management Services is a Registered Nurse who participates as an ... and resource management , cost control, contract compliance, quality improvement, utilization management , denials management and management of… more
- McLaren Health Care (Mount Pleasant, MI)
- …and Responsibilities as Assigned:** 1. Supports activities consistent with Integrated Care Management Denials across all MHC subsidiaries. 2. Accountable for ... responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and… more
- Houston Methodist (Houston, TX)
- …with HM performance that demonstrates leadership responsibility **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... At Houston Methodist, the Director Case Management & Social Services RN position...of opportunities for appropriate utilization of resources to avoid denials and resource management as it pertains… more
- Mayo Clinic (Rochester, MN)
- …Medicare IPPS regulations to support accurate DRG assignment and defend coding-related denials . Experience in utilization review, case management , denials ... but are not limited to, responsibility for reviewing assigned clinically related denials , payer audits, and payer correspondence as well as preparation of relevant… more
- CommonSpirit Health (Centennial, CO)
- …you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all care sites ... BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive experience in utilization review,… more
- WMCHealth (Valhalla, NY)
- …2. Identify opportunities to improve reimbursement. 3. Provide direction to the Case Management staff in relation to denials /appeals which includes training and ... insurance and finance into decision making and problem solving regarding denial management . + Explores strategies to reduce Insurance denials , implements them… more
- Datavant (Nashville, TN)
- …Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal writing for inpatient admission. ... by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal writing… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits for both RAC and non-RAC accounts, reviewing patient records for accuracy in ... the denial and appeal status. + Consults with Coordinator and/or Director, Coding Denials and Appeals during any audit discrepancies. + Attends coding education to… more
- Geisinger (Scranton, PA)
- …Experience Minimum of 3 years-Nursing (Required) Certification(s) and License(s) Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania OUR PURPOSE ... experience is required. The ideal candidate will have prior RN experience in a hospital setting. Case Management...administrative and medical channels to avoid third party payer denials . + Maintains awareness of all concurrent denials… more
- HCA Healthcare (Nashville, TN)
- …Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Compliance Registered Nurse with Parallon you can be a part of an ... our organization. We are looking for an enthusiastic Compliance Registered Nurse to help us reach our...is responsible for providing clinical input or interpretation for denials that have remained unresolved or have been escalated… more
- Houston Methodist (Houston, TX)
- …in utilization review and/or case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact ... Specialist Nurse (URSN) position is a licensed registered nurse ( RN ) who comprehensively...functions through point of entry, observation progression of care management , concurrent review and denials reviews. Additionally,… more
- Catholic Health Services (West Islip, NY)
- …degree required. + Master of Science degree strongly preferred. + Licensure: New York Registered Nurse ( RN ) License & Registration. + Certification: Care ... Supports all CH and consultant initiatives addressing activities relative to Care Management and Denials . + Identifies opportunities for improvement that result… more
