- 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 ... Required Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse...must be in CO, UT, or Kansas.** Must have Clinical Denials experience. Please make sure it's… more
- Nuvance Health (Danbury, CT)
- …delays in reimbursement. This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to all payers, ... Nights available* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are...initial status is to be re-considered. * Identify incomplete clinical reviews in work queues and complete them within… more
- McLaren Health Care (Grand Blanc, MI)
- …of the patient care team. Educates health team colleagues about complex clinical appeals / denials , utilization review, including role, responsibilities tools, ... and methodologies. _Required:_ + State licensure as a Registered Nurse ( RN ) + Bachelor's...documentation, or utilization review experience + Five years of clinical nurse experience in an acute care… more
- Houston Methodist (Sugar Land, TX)
- …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... billing processes, managed care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of CPT and ICD… more
- Stanford Health Care (Palo Alto, CA)
- …Days or + CCDS - Cert Clinical Document Spec required within 180 Days + RN - Registered Nurse - State Licensure And/Or Compact State Licensure preferred ... Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government audits and denials . This position requires… more
- Highmark Health (Monroeville, PA)
- …all regulatory and contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials / appeals and retrospective payer audit ... across the organization in a community setting. **GENERAL OVERVIEW:** Registered nurse who is proficient in the...clinical nursing role + Current State of PA RN licensure OR Current multi-state licensure through the enhanced… more
- Charter Care Health Partners (Providence, RI)
- Summary: The Clinical Appeals - Author performs appeals and denials management and represents the hospital where claims were denied by either ... administrative duties as required. Education/Licensure: Medical Graduate, Physician Assistant or Registered Nurse (Current RI License) Experience: + Knowledge 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 ... education sessions to maintain competency and knowledge of regulations in denials , utilization management, care management, clinical documentation, and… more
- WMCHealth (Valhalla, NY)
- Denials and Appeals Mngmt Cord Company: WMC Advanced Physician Services PC City/State: Valhalla, NY Category: Clerical/Administrative Support Department: ... Details: Job Summary: Decrease the monies lost to insurance companies due to denials . Generate appropriate appeals , both retrospective and concurrent, based on… more
- Children's Mercy Kansas City (Kansas City, MO)
- …necessity review functions utilizing InterQual and/or MCG screening guidelines, and clinical denials / appeals oversight. Participates in department and ... experience + Experience in Utilization Review + One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire + One… more
- Nuvance Health (Danbury, CT)
- …communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and appeal upheld cases in work ... 5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician… 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
- Cognizant (Annapolis, MD)
- …to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...related to clinical denial management and managing clinical denials from Providers to the Health… more
- MVP Health Care (Schenectady, NY)
- …innovative thinking and continuous improvement. To achieve this, we're looking for a **Professional, Clinical Appeals RN ** to join #TeamMVP. This is the ... in New York.** **Qualifications you'll bring:** + Active, unrestricted RN license in good standing + Graduate of an...and clinical guidelines. + Previous experience in clinical appeals , utilization management or managed care… more
- LA Care Health Plan (Los Angeles, CA)
- …the ability to manage multiple training initiatives simultaneously. Licenses/Certifications Required Licensed Registered Nurse ( RN ) - Active, current and ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC ... and grievances to find the root cause of denials . Duties Continued Check, verifies and ensure that all… more
- Providence (Torrance, CA)
- **Description** ** Appeals RN - Care Manager Remote. This position is Per Diem and will work 8-hour, Day shifts.** The Care Management Recovery Advocate (CMRA) is ... Qualifications:** + Associate's Degree Nursing. + Upon hire: California Registered Nurse License. + 2 years Direct...Upon hire: Case management certification. + Experience working with denials and appeals in/for an acute care… more
- Beth Israel Lahey Health (Plymouth, MA)
- … denials . + Responsible for appeals and follow up on clinical denials escalated through a work queue, providing appropriate response supported by ... UR and the analysis, resolution, monitoring & reporting of clinical denials . + Maintains current knowledge of... clinical information. + Provides oversight of the … more
- BronxCare Health System (Bronx, NY)
- …by the department physician advisors and clinical staff. Qualifications - NYS Registered Nurse required - The Appeal Manager must have excellent verbal and ... arrive in letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal… more
- Community Health Systems (Franklin, TN)
- …the denial and appeal status. + Consults with Coordinator and/or Director, Coding Denials and Appeals during any audit discrepancies. + Attends coding education ... quality monitoring and evaluation of work products by the Coordinator and/or Director, Coding Denials and Appeals . + Partners with peers and Director to develop… more
- Actalent (New York, NY)
- Job Title: Medical Necessity Appeals and Denials FacilitatorJob Description This role involves facilitating medical necessity appeals and denials , ... managing notification letters for denials , and reviewing clinical information to determine if medical necessity criteria are...appeals review. + Knowledge of InterQual criteria. + RN or LPN license. Additional Skills & Qualifications +… more