- 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 ... Appeal Specialist II plays a critical role in the Revenue Cycle Denials Management Department by managing and resolving clinical appeals related to government… more
- Stony Brook University (Stony Brook, NY)
- …communication skills while adhering to our high standard of excellence. **Duties of a RN Case Manager in the Care Management Department may include the following ... assigned. Identifies, follows and documents Avoidable delays in Care Management Program. Reviews and documents on patients who were...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is seeking a highly motivated and results-driven **UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical ... to establish the most appropriate course of action + Provides education to nurse and therapist reviewers regarding appeal updates and process changes + Maintains… more
- Beth Israel Lahey Health (Plymouth, MA)
- …making a difference in people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who We Are:** At **Beth ... Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager, you will:** + Directs staff performance regarding UR and… 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
- UNC Health Care (Kinston, NC)
- …preferred. + **EXPERIENCE** + Minimum 3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review, care management , ... or compliance experience preferred. + Minimum 1 year clinical denials management preferred. + **LICENSURE/REGISTRATION/CERTIFICATION** + Licensed to practice as… more
- Nuvance Health (Danbury, CT)
- …and trending all appeals and communicating on a daily/regular basis with the Denials Management team. * Assists with informing Managed Care contracting team ... This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to...required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting… more
- McLaren Health Care (Grand Blanc, MI)
- …including role, responsibilities tools, and methodologies. _Required:_ + State licensure as a Registered Nurse ( RN ) + Bachelor's degree in nursing from ... Summary** : Responsible for assisting the Corporate Director of Denials Management in the coordination of day-to-day...or utilization review experience + Five years of clinical nurse experience in an acute care setting + American… more
- Beth Israel Lahey Health (Beverly, MA)
- … while identifying the issues and providing a proactive appropriate to pre-certification denials management . Serves as a liaison and mentor to the ... multidisciplinary team for questions regarding system-wide processes for the denials management . Identifies opportunities for improving processes for collecting,… more
- Nuvance Health (Danbury, CT)
- …in nursing, health administration, or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience ... and strategy for system-wide care coordination, encompassing utilization review (UR), denials management , discharge planning, social work, and non-clinical… more
- Beth Israel Lahey Health (Plymouth, MA)
- …Transitions Department** and seeking an experienced **Manager of Utilization Review & Denials Management ** and **Utilization Review** **Nurses** to join our ... plays a vital role in ensuring seamless, patient-centered care. ** RN - Utilization Review** This role is ideal for...preferred or in progress **Manager - Utilization Review & Denials Management ** This role is ideal for… more
- Houston Methodist (Houston, TX)
- …leading multi-site or enterprise-level programs preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... exposure to confidential/sensitive information + Proven expertise in throughput optimization, denials management , and team leadership across diverse care… more
- McLaren Health Care (Mount Pleasant, MI)
- …and Responsibilities as Assigned:** 1. Supports activities consistent with Integrated Care Management Denials across all MHC subsidiaries. 2. Accountable for ... responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and… more
- Houston Methodist (Houston, TX)
- …with HM performance that demonstrates leadership responsibility **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... At Houston Methodist, the Director Case Management & Social Services RN position...of opportunities for appropriate utilization of resources to avoid denials and resource management as it pertains… more
- Cognizant (Annapolis, MD)
- …expectations. **What you need to have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...by performing advanced level work related to clinical denial management and managing clinical denials from Providers… more
- CommonSpirit Health (Centennial, CO)
- …you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for all care sites ... BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive experience in utilization review,… more
- AdventHealth (Orlando, FL)
- …medical/hospital nursing experience [Required] + Registered Nurse ( RN ) [Required] **Preferred qualifications:** + Prior Care Management /Utilization ... transitions, patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the… more
- Geisinger (Scranton, PA)
- …Experience Minimum of 3 years-Nursing (Required) Certification(s) and License(s) Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania OUR PURPOSE ... experience is required. The ideal candidate will have prior RN experience in a hospital setting. Case Management...administrative and medical channels to avoid third party payer denials . + Maintains awareness of all concurrent denials… more
- AdventHealth (Winter Park, FL)
- …Degree Nursing + Current valid State of Florida or multistate license as a Registered Nurse + 2 years of medical/ hospital nursing experience **Preferred ... transitions, patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse Case Manager ( RN ) - 2506003132 Description : DMC Detroit Receiving Hospital , Michigan's first Level I Trauma Center, helped pioneer the ... Rosa Parks Geriatric Center of Excellence. Job Summary The RN Case Manager is responsible to facilitate care along... experience preferred. 3. License to practice as a Registered Nurse in the State of Michigan.… more
