- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- Nuvance Health (Danbury, CT)
- *Description* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within the first 12-24 hours ... in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- University of Washington (Seattle, WA)
- …**UW Medicine's Patient Financial Services Department** has an outstanding opportunity for a ** Clinical Appeals and Disputes Nurse .** **WORK SCHEDULE** + ... FTE + 100% Remote + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ...cycle **REQUIREMENTS** + Active licensure to practice as a Registered Nurse in Washington State + Bachelor's… more
- McLaren Health Care (Mount Pleasant, MI)
- …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
- 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 ... care. Use Milliman and Interqual guidelines as necessary. + Collaborates with clinical teams and practices to ensure synchronization of sub-areas' operations to… more
- City and County of San Francisco (San Francisco, CA)
- …( RN ) license issued by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a valid Clinical ... college or university; AND + License and Certification: + Registered Nurse License: Possession of a valid... Certification: The clinical nurse specialist is a BRN certified RN who… more
- State of Colorado (Pueblo, CO)
- NURSE III - Clinical Specialist - Pueblo Regional Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5186234) Apply NURSE III ... of Employment & Appeal Rights Education/Licensure/Certification/Experience: Current, valid licensure as a Registered Nurse from the Colorado Board of Nursing or… 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 Remote PRN Clinical Utilization Review Specialist is responsible...conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate… more
- Hartford HealthCare (Farmington, CT)
- …management and appeals preferred. **Licensure, Certification, Registration** * Active Registered Nurse license from the State of Connecticut * Certified ... and submit appeals for DRG denials, ensuring appeals are well-supported with clinical evidence, coding... Clinical Documentation Specialist (CCDS), Certified Documentation Integrity… more
- UCLA Health (Los Angeles, CA)
- …self-directed individual with: * Bachelor's degree in health-related field, preferred * A Registered Nurse ( RN ) license or MD diploma (or equivalent) ... at UCLA Health. You will become a member of our highly successful Clinical Documentation Integrity and Denial Management team, including all modalities. This role… more
- Houston Methodist (Sugar Land, TX)
- …of care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS** **Required** + RN - Registered Nurse - Texas State Licensure - ... review, case management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level… more
- University of Southern California (Arcadia, CA)
- …requirements impact DRG assignments. + Minimum of three years' experience in clinical disciplines ( RN , MD, FMG) or utilization review/case management in ... Documentation Improvement Practitioner (CDIP) certification status preferred. + Certified Clinical Documentation Specialist (CCDS) credential preferred. Pay… more
- CaroMont Health (Gastonia, NC)
- …for promoting and monitoring safe, high-quality, cost-effective healthcare with the best clinical outcomes possible. Provide physician and nurse education to ... and reporting. Perform data collection and analysis, trend identification for assigned clinical outcomes, and present this data at the appropriate meetings as… more
- Molina Healthcare (Rio Rancho, NM)
- …and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must be active and unrestricted ... a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/ appeals . + Provides training and support to clinical peers. +… more
- St. Peters Health (Helena, MT)
- …providers is an essential requirement for this role. EDUCATION: * Clinical preparation; RN required LICENSE/CERTIFICATION/REGISTRY: Nursing licensure in the ... The Utilization Management RN reports directly to Utilization Review RN...admission status and confirm treatment goals, treatment plan, and clinical mileposts used to advance the treatment plan. 12.… more
- BriteLife Recovery (Englewood, NJ)
- …clinical information and advocating for appropriate levels of care. The UR Specialist works closely with clinical staff, admissions, medical providers, and ... What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible for… more
- SUNY Upstate Medical University (Syracuse, NY)
- …preparing regulatory notices for delivery to the patient Minimum Qualifications: NYS Licensed/ Registered (or eligible) RN , Bachelor's Degree in Nursing, and a ... Job Summary: The UR-CR Specialist I is primarily responsible for ensuring that...minimum of three years post RN licensure acute care nursing experience, or Associate's Degree… more
- UnityPoint Health (Cedar Rapids, IA)
- …This position is on site at St. Luke's Hospital. The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments serves a key role in ... utilization of health care resources, provision of high-quality health care, optimal clinical outcomes and patient and provider satisfaction. The UM Specialist … more
- State of Colorado (Denver, CO)
- …Rights MINIMUM QUALIFICATIONS: + Applicant must possess a current, valid license as a Registered Nurse from the Colorado Board of Nursing or any state ... Applicant must have three (3) years of full-time experience providing patient care as a Registered Nurse . W ork experience less than full time will be prorated.… more
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