- NavitsPartners (Boston, MA)
- Job Title: Travel - Registered Nurse (RN) - Case Management Location: Hyannis, MA Assignment Type: Travel Contract Duration: 13 Weeks Shift: Monday to Friday | 8:00 ... $2,762 - $2,890 Position Overview: We are seeking an experienced Registered Nurse (RN) specializing in Case Management for a 13-week travel assignment in… 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 ... integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those… more
- Zenith (Sarasota, FL)
- …leadership. This position can be filled in ANY Zenith Branch Responsible for clinical review and analysis and appropriate adjustment of billing as needed based on ... rules and medical compliance/standards. Consults Legal on bill reimbursement and state appeals . Evaluates and negotiates high dollar bills that have the potential… more
- Central Health (Austin, TX)
- …team members and Network Services to improve the patient experience and positive clinical outcomes. The Utilization Management RN will use their clinical ... of treatment and may also be involved in the appeals process when necessary. In this role, the Utilization...process when necessary. In this role, the Utilization Management nurse play a crucial role in improving the efficiency… more
- NYC Health Hospitals (New York, NY)
- …should be appealed or accepted and assigning the appealable denials to the Clinical Appeal Staff and Attending Physicians to appeal. 10. Supervise the writing of ... Medical and Behavioral Health Appeals of denial of hospitalization coverage for inpatients by...as well as edit Appeal Letters written by the Clinical Appeal Staff and Attending Physicians. 11. Coordinate and… more
- Kaiser Permanente (Aurora, CO)
- …region. Manages utilization review staff working collaboratively with UM physicians and clinical appeals team, supervises the activities of the unit staff, ... feedback to UR staff on a monthly basis. Essential Responsibilities: Manages the clinical team and or teams that complete medical necessity reviews for authorization… more
- California Rehabilitation Institute (Los Angeles, CA)
- …intervention as part of the discharge planning process. Responsibilities Clinical Interventions/Discharge and Care Planning Management: Responsible for functioning ... overseeing negotiations of continued stay rationale, length of stays, and appeals process. Initiates activities to develop positive business relationships with… more
- AndHealth (Columbus, OH)
- …adjusted. Own completing, submitting, documenting, and tracking prior authorizations and appeals . Understand what clinical criteria are required by medications ... as well as with pharmacies. Consult with pharmacists or providers regarding all clinical needs of patients, routing all clinical interventions or counseling to… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- Ready to help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound ... regulatory timeframes.The TeamAs an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a liaison and business expert… more
- Molina Healthcare (Midvale, UT)
- …for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... _For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...with internet connectivity of high speed required._ **Job Summary** Clinical Appeals is responsible for making appropriate… more
- R1 RCM (Boise, ID)
- …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help our ... remote, production-driven position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review of patient medical… more
- Corewell Health (Southfield, MI)
- …when the third-party payors do not meet the expected payment as modeled. The Clinical Appeals Nurse will write comprehensive, factual arguments to present ... RN License Scope of Work: Responsible for completing retrospective clinical appeals for full or partially denied...Required + Background in Case Management. Preferred + Registered Nurse (RN) - State of Michigan Will consider out… more
- Intermountain Health (West Valley City, UT)
- …write up clinical reviews for insurance audits and governmental insurance appeals using supporting documentation. 2. Assesses the appropriateness of clinical ... State regulations. 3. Works with Physician Advisors to obtain clinical support for appeals if needed. 4. Collaborates with Care Management, Utilization Review,… more
- Guidehouse (New York, NY)
- **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** + Performs chart ... of care or observation services based on physician certification + Gathers clinical information to conduct continued stay utilization review activities with payers… more
- Elevance Health (Tampa, FL)
- ** Nurse Appeals - Medicare** **Location:** Virtual:.../grievances/quality of care issues and is a resource for clinical and non clinical team members in ... employment, unless an accommodation is granted as required by law. The ** Nurse Appeals - Medicare** is responsible for investigating and processing and medical… more
- R1 RCM (Boise, ID)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Supervisor** , you will help support clinicians ... position. **Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor...additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- BronxCare Health System (Bronx, NY)
- …arrive in letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal ... Overview The Appeals Manager is responsible to assist in the...preferred. The Appeal Manager should have experience as a nurse in acute care clinical setting who… more
- State of Colorado (Denver, CO)
- NURSE III- Clinical Risk Manager Print...of the department's action. For more information about the appeals process, the official appeal form, and how to ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5013009) Apply NURSE III- Clinical Risk Manager Salary $8,369.00 - $11,717.00 Monthly Location… more
- City and County of San Francisco (San Francisco, CA)
- …assists with designing and implementing plans for meeting such needs. The Clinical Nurse Specialist performs other related duties as assigned/required. Minimum ... by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
Related Job Searches:
Appeals,
Appeals Nurse,
Clinical,
Clinical Appeals Nurse RN,
Clinical Nurse,
Nurse,
Nurse Clinical Appeals Specialist