- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, ... JOB DUTIES AND RESPONSIBILITIES: Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- Regal Medical Group, Inc. (West Covina, CA)
- …policies, procedures and goals and ensure that the QI P & P are followed. QI Team Nurse Specialist is a key member of the QI Department and Assists QI staff as ... as an intra-team contact for staff for questions on appeals and grievances and offers assistance as may be...order to promote good patient health outcomes. QI Team Nurse Specialist may produces charts, graphs, reports… more
- Molina Healthcare (Midvale, UT)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... with internet connectivity of high speed required._ **Job Summary** Clinical Appeals is responsible for making appropriate...more of the following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist … more
- City and County of San Francisco (San Francisco, CA)
- …and assists with designing and implementing plans for meeting such needs. The Clinical Nurse Specialist performs other related duties as assigned/required. ... by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- City and County of San Francisco (San Francisco, CA)
- … Nurse (RN) license issued by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a valid Clinical ... general medical and nursing direction, you will perform pediatric clinical nursing duties in hospitals, clinics, and community health...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- Dana-Farber Cancer Institute (Brookline, MA)
- The Cell Therapy Clinical Authorization Specialist is responsible for the comprehensive coordination and management of all prior authorization activities ... for insurance waivers and non-covered services. + Collaborate closely with physicians, nurse coordinators, and interdisciplinary clinical teams to gather and… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve ... plans. Reporting to the Prior Authorization Supervisor , the Clinical Authorization Specialist is responsible for managing...+ Root causes claim denials, reprocesses, and submits claim appeals . + Creates drug cost estimates for both on-label… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- Trinity Health (Des Moines, IA)
- …Join the MercyOne Family! We are looking to hire a RN Clinical Integration Specialist . The purpose of the Clinical ... requirements that improve outcomes and reduce harm to patients. The specialist works closely with ministry colleagues, providers, and leaders in implementing,… more
- LifePoint Health (Hickory, NC)
- *Registered Nurse (RN), Clinical Case Manager* PRN * * *Your experience matters* At Frye Regional Medical Center, we are driven by a profound commitment to ... and harassment in employment." **Job:** **Nursing* **Organization:** ** **Title:** *Registered Nurse (RN), Clinical Case Manager PRN* **Location:** *NC-Hickory*… more
- Mount Sinai Health System (New York, NY)
- …for appeals , On / Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days...Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status… more
- Clark County, NV (Las Vegas, NV)
- …candidates for the Specialty Courts Specialist position. The Specialty Courts Specialist will provide clinical mental health and substance abuse evaluations ... SPECIALTY COURTS SPECIALIST Print (https://www.governmentjobs.com/careers/clarkcounty/jobs/newprint/5007217) Apply SPECIALTY COURTS SPECIALIST Salary $35.96 -… more
- State of Michigan (Lansing, MI)
- Departmental Specialist 13 - Specialized Nursing Home OBRA Program Print (https://www.governmentjobs.com/careers/michigan/jobs/newprint/4996564) Apply Departmental ... Specialist 13 - Specialized Nursing Home OBRA Program Salary.... Reviews, coordinates and represents the Department on statewide appeals of preadmission screenings/annual resident reviews Medicaid recoveries before… more
- State of Colorado (Denver, CO)
- CDOC Mid Level Provider / Nurse Manager - (DENVER) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5019611) Apply CDOC Mid Level Provider / ... Nurse Manager - (DENVER) Salary $8,788.00 - $12,302.00 Monthly...day for the nursing management and administration of a clinical unit; + Provide leadership and vision while supervising,… more
- State of Colorado (Sterling, CO)
- CDOC Registered Nurse - Part-time - Sterling Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4992041) Apply CDOC Registered Nurse - ... Sterling, CO Job Type Part Time Job Number CAA Nurse I SCF 07/2025 Department Department of Corrections Division... I SCF 07/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 07/01/2025 Closing Date… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4963973) Apply CDOC Registered Nurse ( Nurse I) ... $10,627.00 Monthly Location Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 06/2025 Department Department of Corrections Division Clinical and… more
- State of Colorado (Limon, CO)
- LICENSED PRACTICAL NURSE - (LIMON) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4968134) Apply LICENSED PRACTICAL NURSE - (LIMON) ... treatment plans, employs infection control measures, provides referral to appropriate Clinical Services staff for new arrivals, crisis intervention, interviews and… more
- Trinity Health (Livonia, MI)
- …including but not limited to, appending modifiers, and checking clinical documentation. Provides feedback to intra-departmental Revenue Integrity colleagues ... productivity standards + Maintains compliance with regulatory requirements Assist Nurse Auditor and/or Coordinator with denial coordination process; including… more
- Hartford HealthCare (Farmington, CT)
- …Registration* * RN licensed in the state of CT *And* * Certified Clinical Documentation Specialist (CCDS) certification or Certified Clinical Documentation ... manages an effective and comprehensive Health Information Management (HIM) Clinical Documentation Integrity (CDI) quality, audit, education, and denials prevention… more
- State of Colorado (Sterling, CO)
- …diagnosis, and treatment for acute, chronic, and emergency care for inmates in the clinical setting, which could include a clinic, an infirmary, or a special needs ... and other related laboratory tests; + Follow the CDOC clinical services standards and procedures, protocols, guidelines, or policies...must possess current, valid licensure as an Advanced Practice Nurse / Nurse Practitioner from the Colorado… more
