- MaineGeneral Health (Augusta, ME)
- Job Summary: MaineGeneral Health is seeking a qualified RN Clinical Appeals Specialist to support our Revenue Cycle team by reviewing denied insurance claims ... MaineGeneral's mission of exceptional patient care Job Description: Position: RN Clinical Appeals Specialist Location:...patient care Job Description: Position: RN Clinical Appeals Specialist Location: Alfond Center for Health,… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
- Ochsner Health (New Orleans, LA)
- …- Experience in Appeal/Denial Management **Certifications** Required - Current State of Louisiana Registered Nurse ( RN ) License Preferred - Certification in ... relates to all medical necessity audits. **Education** Required - Registered Nurse Diploma Preferred - Associate's or...experience in the delivery of patient care as an RN . Experience in Case Management, Utilization Review and/or Discharge… more
- Aerotek (Tampa, FL)
- …including an explanation of the final decision and all External appeal rights. Licenses/Certifications RN - Registered Nurse - State Licensure And/or Compact ... **Description** PURPOSE: The Clinical Appeals Specialist completes research basic analysis...Certified Case Manager Upon Hire Pref LNCC - Legal Nurse Consultant Certified Upon Hire Pref **Pay and Benefits**… more
- State of Colorado (Sterling, CO)
- CDOC Registered Nurse - Part-time - Sterling Print...Yes + No 06 Do you possess an active RN license issued by an Enhanced Nurse Licensure ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4756062) Apply CDOC Registered Nurse - Part-time - Sterling Salary...Colorado? If so, what state issued your license? 07 Nurse Licensure Compact: If appointed to an RN… more
- Molina Healthcare (Provo, UT)
- … appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of ... these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. **Preferred… 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/4963973) Apply CDOC Registered Nurse ( Nurse I) Salary $7,442.00 Monthly Location Statewide,… more
- City and County of San Francisco (San Francisco, CA)
- …At least one (1) year of experience working as a Registered Nurse SPECIALTY REQUIREMENTS: + Clinical Documentation Specialist (CCDS) certification + At least ... Possession of a valid permanent/temporary (including interim permit) California Registered Nurse License (**IMPORTANT: Be sure to... License (**IMPORTANT: Be sure to include your California RN license number in the application, as failure to… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA and other...+ Communicate and work collaboratively with AG Representatives, Resolution Specialist and Management to maintain and improve quality of… more
- BayCare Health System (Tampa, FL)
- …duties as assigned. The Nurse Care Coordinator, RN **Requirements:** + RN ( Registered Nurse ) License + Required Associate's or Diploma Nursing + ... and clinical excellence. **Are you a passionate and dedicated Nurse Care Coordinator, RN seeking a flexible...calls, walk-in triage, and medication refill requests + Coordinate specialist referrals/ Appeals and ensure timely follow-up +… more
- Baptist Memorial (Memphis, TN)
- Overview Specialist -Denial Mitigation II RN Job Code: 21432 FLSA Status Job Family: FINANCE Job Summary * Position may be filled in Memphis, TN; Jackson , MS The ... Denial Mitigation-Appeal Specialist II RN serves in a key...maximize customer satisfaction. + Submits retro-authorization requests, reconsiderations, and appeals with careful regard to payer specific timeframes, contractual… more
- Baptist Memorial (Memphis, TN)
- …Summary * The position may be filled in Memphis, TN; Jackson, MS The Denial Mitigation-Appeal Specialist II RN serves in a key role of the BMHCC revenue cycle as ... claims and denial resolution in order to defend our revenue. The Denial Mitigation-Appeal Specialist II RN reviews the denial received from the payer, completes… more
- Trinity Health (Des Moines, IA)
- …72 hours biweekly Day Shift **General Requirements:** + Iowa licensure as a Registered Nurse . + Member of a professional healthcare organization. **Education:** ... the MercyOne Family! We are looking to hire a RN Clinical Integration Specialist . The purpose of...and Medicaid Services (CMS), Iowa Department of Inspections and Appeals (IDIA), The Joint Commission (TJC),etc.), in conjunction with… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks ... preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending....an accredited, professional nursing program. + Must have current RN license to practice in the state of Pennsylvania… more
- City and County of San Francisco (San Francisco, CA)
- …and Certification: + Registered Nurse License: Possession of a valid California Registered Nurse ( RN ) license issued by the California Board of ... Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a valid...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)
- …Therapy and/or Prior Authorization experience is preferred. + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. **KNOWLEDGE, SKILLS, ... The Cell Therapy Clinical Authorization Specialist is responsible for the comprehensive coordination and management of all prior authorization activities specific to… 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 Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to… 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
- University of Virginia (Charlottesville, VA)
- …Experience: 2 years acute care hospital experience. Licensure: Licensed to Practice as a Registered Nurse in the Commonwealth of Virginia required or a compact ... Under general direction: The Utilization Management RN serves as a leader resource in the...appealed utilizing medical, contract and payor rules. + Conducts appeals with external entities and Consultants. + Manages appealed… more
- Commonwealth Care Alliance (Boston, MA)
- 011340 CCA-Portfolio Management **Position Summary** The Specialist , Enrollment Reconciliation documents and conducts procedures related to the reconciliation of ... Medicaid and Medicare enrollment membership and corresponding premium. The Specialist submits enrollment data and reviews regularly received reports from the Center… more
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