- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Elevance Health (Tampa, FL)
- ** Nurse Appeals - Medicare** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... an accommodation is granted as required by law. The ** Nurse Appeals - Medicare** is responsible for...would provide an equivalent background. + Current active unrestricted RN license to practice as a health professional within… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound clinical judgement to ... integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a...to assist with medical necessity determinations. Key Qualifications: + Registered Nurse with an active unrestricted professional… more
- R1 RCM (Boise, ID)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Nurse ** , you will help our hospital clients by ... **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review...at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position,… more
- Molina Healthcare (Midvale, UT)
- **JOB DESCRIPTION** _For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state of UTAH or have a compact license._ _This ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of… 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/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 (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 (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
