- Cottage Health (Goleta, CA)
- Job Description Cottage Health seeks a Utilization Review Manager, Registered Nurse for their Clinical Denials and Appeals department responsible for the ... overall management of utilization review processes and clinical denials between Cottage Health and outside payers. The manager is also responsible for processes… more
- BRISTOL HOSPITAL GROUP (Bristol, CT)
- …Full Time Education Level 4 Year Degree Job Shift 1st Shift (Days) Description Registered Nurse Utilization Reviewer At Bristol Health, we begin each day caring ... inpatient care. Essential Job Functions and Responsibilities: The UM, Registered Nurse role is to provide direct...nurse additionally helps the team to understand the clinical guidelines and criteria sets used to support medical… more
- Arnot Health (Elmira, NY)
- …an approved registered nursing program with a current license as a registered nurse . BSN or Case Management Certification preferred. EXPERIENCE: Three years ... Manager tracks and trends LOS, resource utilization, outliers, readmissions, denials , delay days and satisfaction of the case managed...clinical nursing in acute care hospital setting or two… more
- Riverside Health System (Hampton, VA)
- …Proficiency with computer systems required to perform job Licenses and Certifications Registered Nurse (RN) - Virginia Department of Health Professions (VDHP) ... and facility leadership. Ensures timely notification and communication of pertinent clinical data to support admission, clinical condition, and continued… more
- Guidehouse (Huntsville, AL)
- …None **Clearance Required** **:** None **What You Will Do** **:** The **R** **emote** ** Clinical Denials RN** is responsible for review, analysis and appeal of ... **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:**...clinical denials from insurance companies and third-party payers. This role… more
- Catholic Health Initiatives (Little Rock, AR)
- …State of Arkansas Bachelors Of Nursing Or related healthcare field Minimum three (3) years clinical experience as Registered Nurse (RN) 5 years of RN ... The RN has an integral role within the revenue cycle by providing clinical expertise in the denials management process. The Denials RN performs a root cause… more
- Trinity Health (Hartford, CT)
- …in development of action plans to ensure goals are met **Minimum Qualifications** + Registered Nurse (RN) or Licensed Vocational Nurse / Licensed Practical ... of patient access, revenue cycle and denial management functions; technical and clinical denials areas, such as medical necessity, eligibility issues, no… more
- Children's Mercy Kansas City (Kansas City, MO)
- …per contracts for medically appropriate level of care. Manages concurrent clinical denials through completion of verbal reconsideration process. Works ... children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes ...+ One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon… more
- Texas A&M University System (College Station, TX)
- Job Title Registered Nurse II - Prior Authorization & Referral Agency Texas A&M University Health Science Center Department University Health Services Proposed ... and team-based health care delivery. What we want The Registered Nurse II-Prior Authorization and Referral, under...are denied. + Collaborate with providers to gather necessary clinical documentation and address denials or escalations.… 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 ... through appropriate administrative and medical channels to avoid third party payer denials . + Maintains awareness of all concurrent denials through interaction… more
- Crouse Hospital (Syracuse, NY)
- …requirements and contractual agreements. Manager, Care Coordination Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree + Five ... Managers in the department, including Utilization Management, Discharge Planning and Denials and Appeals functions. + Assessing workflow related to readmission… more
- R1 RCM (Boise, ID)
- …appeals.Represent clients at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay ... analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help...clients by serving as an expert on appeals and denials management where claims were denied by either governmental… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a **Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, Barksdale ... One year of experience in Utilization Management is required. Full time employment as a registered nurse within the last 36 months is mandatory. Six years of … more
- AdventHealth (La Grange, IL)
- …AND EXPERIENCE REQUIRED:** . Associates Degree Nursing or RN Diploma degree . Registered Nurse (RN) . Two (2) years of medical/hospital nursing experience ... **LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:** . State of Illinois registered nurse license **LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:**… more
- Bon Secours Mercy Health (Warren, OH)
- …* Be mindful of revenue cycle components including scheduling, registration, clinical coverage/treatment, documentation, billing, collections, and denials . * ... effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Summary of Primary Function/General Purpose of… more
- AdventHealth (Hinsdale, IL)
- …Discharge Planning + Conflict management and resolution skills + Teamwork principles + Registered Nurse (RN) Required + Certified Case Manager (CCM) Preferred + ... Manager ensures efficient and cost-effective care through appropriate resources monitoring, and clinical care escalations. The RN Care Manager is under the general… more
- Beth Israel Lahey Health (Plymouth, MA)
- … clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient. ... or advanced degree in healthcare preferred. + Three years recent, broad clinical experience in the hospital setting + Experience with utilization management within… more
- AdventHealth (Altamonte Springs, FL)
- …Degrees without out-of-pocket tuition expense) *For eligible positions* + Nursing Clinical Ladder Program*For eligible positions* + Whole Person Well-being and ... Manager ensures efficient and cost-effective care through appropriate resources monitoring, and clinical care escalations. The RN Care Manager is under the general… more
- AdventHealth (Winter Garden, FL)
- …Degrees without out-of-pocket tuition expense) *For eligible positions* + Nursing Clinical Ladder Program*For eligible positions* + Whole Person Well-being and ... Manager ensures efficient and cost-effective care through appropriate resources monitoring, and clinical care escalations. The RN Care Manager is under the general… more
- Children's Mercy Kansas City (Kansas City, MO)
- …skills in a previous role + One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire + One of the following: ... risk administrative processes and data related to medical necessity denials , clinical appeals, long length of stay...Licensed RN - Kansas, Registered Nurse Multistate License Kansas required upon… more
