- Stanford Health Care (Palo Alto, CA)
- …180 Days or + CCDS - Cert Clinical Document Spec required within 180 Days + RN - Registered Nurse - State Licensure And/Or Compact State Licensure preferred ... excellent analytical and communication skills. The Clinical Government Audit Analyst and Appeals Specialist II will collaborate with clinical staff, coding… more
- Commonwealth Care Alliance (Boston, MA)
- …provider community. In this highly visible field position, the provider relations specialist acts as the primary liaison between CCA and its providers including ... Referral and authorization; Regulatory compliance; Billing and payments; Complaints and appeals ; Policies and procedures. + Identify opportunities for training and… more
- HCA Healthcare (Nashville, TN)
- …UT, VA). Do you want to join an organization that invests in you as a Clinical Appeals Specialist Medicare RN or LPN? At Parallon, you come first. HCA ... you have the opportunity to make a difference. We are looking for a dedicated Clinical Appeals Specialist Medicare RN or LPN like you to be a part of our… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- CommonSpirit Health (Centennial, CO)
- …with resources to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management ... BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive experience in utilization review,… more
- Community Health Systems (Franklin, TN)
- …of insurance claims processing and denial management workflows. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact ... supports initiatives that improve denial prevention and recovery processes. As an Appeals Specialist II at Community Health Systems (CHS) - SSC Nashville, you'll… more
- Intermountain Health (Des Moines, IA)
- …personnel and works closely with Intermountain Health legal team, Physician Advisors, and Appeals RN consultants in their various capacities. **We are committed ... **Job Description:** The RCO Appeals Hearing Specialist is responsible for...meetings** + **Essential Functions** + Serves as the Intermountain Appeals liaison to Legal, Appeals RN… more
- Nuvance Health (Danbury, CT)
- …Days, Evenings, Nights available* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within ... notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the...* Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum of… more
- McLaren Health Care (Mount Pleasant, MI)
- …of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and achieve optimal ... other related duties as required and directed. **Qualifications:** **_Required:_** + Registered Health Information Technician (RHIT), Licensed Practical Nurse … more
- Molina Healthcare (Salt Lake City, UT)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal appeals clinical processes - ensuring that appeals ... quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours: Monday- Friday...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Beth Israel Lahey Health (Cambridge, MA)
- …to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality data by ... on the key performance indicators and quality measures, the RN specialist also aims to foster a...reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts,… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print...RN license. 07 Do you possess an active RN license issued by an Enhanced Nurse Licensure ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5123731) Apply CDOC Registered Nurse ( Nurse I) Salary $7,591.00 - $10,627.00 Monthly… more
- Cedars-Sinai (CA)
- …as a condition of continued employment. **Req ID** : 13443 **Working Title** : Registered Nurse Care Coordinator- Inpatient Specialty Program - 8 Hour Days $5K ... Investigates, processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate policy. + Begins… 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
- Louisiana Department of State Civil Service (Hammond, LA)
- …12-month period. DUE TO ACT 421 REQUIREMENTS, THE INCUMBENT MUST BE A LICENSED REGISTERED NURSE . Compensation: Salary may be negotiable depending on the chosen ... MEDICAL CERTIFICATION SPECIALIST 2-WAE (PRN) Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/5138602) Apply MEDICAL CERTIFICATION … more
- Beth Israel Lahey Health (Beverly, MA)
- …**Job Description:** Job Description **Position Summary:** The Clinical Denials Specialist assesses, plans, coordinates, and evaluates initial and ongoing ... all denials occurring as related to observation and inpatient stays. The denials specialist researches and responds to denials in a timely fashion. He/she identifies… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... **Job Summary** The Part-Time Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital… more
- AmeriHealth Caritas (Philadelphia, PA)
- …; **Education/ Experience:;** + Bachelor's degree or equivalent relevant experience + Unrestricted Registered Nurse ( RN ) or Physical Therapist (PT) + Valid ... Modification and LTSS UM Department, including authorization and approval of services, appeals and the coordination of benefits for all LTSS Participants. + Assists… more
- Independent Health (Buffalo, NY)
- … Health Information Technician (RHIT), Certified Clinical Documentation Specialist (CCDS), American Health Information Management Association (CCS-H, CCS-P), ... growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist -Senior will be responsible for reviewing coding and clinical...Certification Denials and Appeals Management (C-DAM), or NYS licensed RN … more
- TEKsystems (Canoga Park, CA)
- …adjudication. This role is ideal for a Licensed Vocational Nurse (LVN) or Registered Nurse ( RN ) with hands-on experience in Utilization Management (UM) ... Participate in special projects related to claim denials and appeals Required Qualifications: + Active LVN or RN... appeals Required Qualifications: + Active LVN or RN license (California) + 2+ years of experience in… more
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