- Denver Health (Denver, CO)
- …Must Be a Colorado Resident Job Summary Under minimal supervision, the Registered Nurse , Grievance & Appeals is responsible for assessing and completing ... in a managed care health insurance plan required . Previous grievance and appeals experience preferred. Licenses : RN-Registered Nurse - DORA - Department… more
- DaVita, Inc. (Conyers, GA)
- …think over when speaking with our team: Why working with dialysis patients appeals to you (opportunity to develop relationships, etc.) Your thoughts on teamwork ... working in a fast-paced environment DaVita is seeking a Nurse who is looking to give life in an...(ER), or Medical Surgical (Med Surg) experience Certified Nephrology Nurse (CNN) or Certified Dialysis Nurse (CDN)… more
- MLee Healthcare Staffing and Recruiting, Inc (Granger, IA)
- Registered Nurse - Med / Surg & Emergency Room Great Benefits / Competitive Salary / Full Time We are seeking a highly motivated and compassionate Registered ... Nurse to join our growing team in Iowa. This...schooling, and year-round community-based activities are among the many appeals to this position. Qualifications: Graduate from an accredited… more
- AltaMed Health Services Corporation (Montebello, CA)
- …forward every day. Job Overview The Quality Specialist is a California licensed nurse responsible for collecting, analyzing, and mining quality data metrics, as per ... all managed care activities (eg, UM, CM, Claims, Member Services, Appeals and Grievances, Credentialing, Provider Network) tracks and trends specified… more
- The Emily Program (Atlanta, GA)
- …our clients at all levels of care. Position Overview The Psychiatric Nurse Practitioner is responsible for conducting psychiatric assessments and providing treatment ... 30346 Take a Virtual Tour of our Atlanta Site How Psychiatric Nurse Practitioners Empower Recovery Provide direct psychiatric services through the comprehensive… more
- Blue Shield of California (Rancho Cordova, CA)
- …with members care including clinical nurses and treating MDs.. The Case Management Nurse , Senior will report to the Manager, Care Management. In this role you ... Provide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD) Recognize the clients right to self-determination… more
- Blue Shield of California (Long Beach, CA)
- …Work Schedule M-Th 10:30-7:00 F 9:30-6:00 Your Role The Behavioral Health Registered Nurse Case Manager will report to the FEP Department Manager. In this role ... Provide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD) Recognize the clients right to self-determination… more
- MLee Healthcare Staffing and Recruiting, Inc (Greenfield, IA)
- Registered Nurse - Med / Surg & Emergency Services Great Benefits / Competitive Salary / Full Time This location offers plenty for a true nature lover with stunning ... good schooling, and year-round community-based activities are among the many appeals to this position. Qualifications: Graduate from an accredited school of… more
- Veterans Care Centers of Oregon (Lebanon, OR)
- LPN Charge Nurse Wages DOE: $30 - $38.22 NOC Shift...*Current CPR and First Aid certification required. If this appeals to you contact Cheryl Walter, DNS at ### ... Nurses! Ask about our Career Path Educational Assistance Program and the Nurse Student Loan Reimbursement Program Benefits ?Competitive wage scale based on… more
- Emonics LLC (Los Angeles, CA)
- …Required: BLS Position Responsibilities/Expectations *Medication coordination (communication with pharmacy, appeals , faxes, pt calls about meds, dosage etc) *Patient ... coordination (calls, triaging, messages) *Provider support (rooming, pre-charting, assisting with procedures) *Pre-op instructions to patient. Skills Required: Great communication, ability to triage phone calls, room patients, CSLINK/EPIC proficiency/… more
- Molina Healthcare (Long Beach, CA)
- …for medical necessity. Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of ... reviews and recommends corrective actions. Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. Attends… more
- Rasmussen University (Minneapolis, MN)
- Dean of Nursing and Nurse Administrator Rasmussen University Brooklyn Park, MN The Dean of Nursing & Administrator serves as the nurse leader for the nursing ... partners, the healthcare community, and other relevant constituencies. Process SAP appeals in conjunction with a student advisor; responsible for making… more
- Pioneer Healthcare (Indianapolis, IN)
- …Manager Job Description: If you want to make a significant impact as a Registered Nurse - Case Manager in Indianapolis, IN this position might be what you are ... professionals to ensure continuity of care. Coordinate insurance authorizations, appeals , and approvals for necessary medical services and treatments.… more
- Mount Sinai Hospital (New York, NY)
- …hospital personnel as needed. The Nursing Clinical Manager collaborates with Appeals Management, Managed Care Contracting and other institutional departments to ... monthly Nursing Department meetings. 5. Works with unit case managers, clinical nurse managers, physicians, and social work to facilitate Interdisciplinary Rounds to… more
- Trinity Health (Berwyn, IL)
- …Description: The Lead Case Manager position reports to the Manager of Nurse Care Management. Their specific duties include: Recruiting, interviewing, hiring, and ... reporting of financial indicators including care readmission rates, denial and appeals . Use data to drive decisions and plan/implement performance improvement… more
- Pioneer Healthcare (Salinas, CA)
- …Salinas, CA Job Description: If you want to make a significant impact as a Registered Nurse - Case Manager in Salinas, CA this position might be what you are looking ... professionals to ensure continuity of care. Coordinate insurance authorizations, appeals , and approvals for necessary medical services and treatments.… more
- Corewell Health (Royal Oak, MI)
- …when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization for care and ... care management, utilization review, home care and/or discharge planning. Preferred Registered Nurse (RN) - State of Michigan License Upon Hire required Basic Life… more
- HC&N Healthcare Solutions (West Palm Beach, FL)
- …Medicare, Managed Medicaid and Commercial) concurrent reviews Initiate and track insurance appeals for admission denials and continued stay Schedule UAS with Managed ... All other duties as assigned Requirements/Qualifications: Current FL Licensed Registered Nurse MDS experience required and a working knowledge of Insurance contracts… more
- Wealthy Group of Companies LLC (Overland Park, KS)
- …direct oversight of the ClinicalDirector, Director of Nursing, staff Nurse Practitioners, andFacilities Director, while leading and mentoring a multidisciplinaryteam ... insurance-drivencare models, while overseeing denial trends, analyzing patterns, andsupporting appeals when appropriate to maximize reimbursement andclient retention in… more
- BioSpace (Detroit, MI)
- …Must be able to effectively collaborate across all corporate functions-MSLs, TLLs, Nurse Coordinators, Field Access Team, supporting sales teams, etc. Key account ... policies and processes (eligibility and benefit verification, prior-authorization and appeals /denials) Improve use of marketing resources to maintain and develop… more
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