- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... with dynamic goals resulting in the full and fair review of appeals and grievances designed to...and utilization management, and systems software used in processing appeals . + Knowledge and understanding of medical … more
- ManpowerGroup (Columbia, SC)
- …School of Nursing. + 2 years clinical experience plus 1 year in utilization/ medical review , quality assurance, or home health. + An active, unrestricted ... Appeals , you will be part of the clinical review department supporting the appeals team. The...benefit analysis to determine if the requested services meet medical necessity guidelines. + Document decisions within mandated timeframes… more
- R1 RCM (Boise, ID)
- …orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to draft appeals of denied and underpaid ... experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical...external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + An active CCS,… more
- Commonwealth Care Alliance (Boston, MA)
- …or written communication. + Identify potential quality of care issues within medical appeals ; escalate as appropriate. + Collaborate with internal areas ... 011540 CCA- Appeals & Grievances **Position Summary:** Investigate and resolve medical necessity member appeals . Ensure compliance with state and federal… more
- R1 RCM (Detroit, MI)
- …conduct a comprehensive review of clinical denials and formulate appeals based on clinical documentation, evidence-based medical necessity criteria, ... identify targeted areas for additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay… 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 ... leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical...medical necessity outreach, and feedback to the utilization review team on denial outcomes. * *Discharge Planning &… more
- State of Colorado (Denver, CO)
- …(HP III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4966056) Apply Registered Nurse Health Compliance Inspector Home Care - ... Registered Nurse Health Compliance Inspector Home Care -...FAA00601 (HP III RN ) Salary $72,336.00 Annually Location Denver, CO Job Type Full Time… more
- State of Colorado (Denver, CO)
- …III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4966096) Apply Registered Nurse Health Compliance Inspector, Nursing ... Registered Nurse Health Compliance Inspector, Nursing...Facilities - FAA00392 (HP III RN ) Salary $72,336.00 Annually Location Denver, CO Job Type… more
- Ascension Health (Jacksonville, FL)
- …rules and regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse obtained prior to hire date or job transfer ... + Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals ....date. Licensed as a Registered Nurse in Florida. Credentialed from State… more
- Ascension Health (Tulsa, OK)
- …management rules and regulations. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Oklahoma Board of Nursing ... cases. + Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals . +… more
- Mount Sinai Health System (Long Island City, NY)
- …field. **Licensing and Certification Requirements (if applicable)** Licensed as a registered nurse , Issuing Agency: Department of Health/Office of Professions ... The Director will direct and manage departmental activities involved in utilization review , appeals management and discharge planning to facilitate the case… 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, ... Immune Effector Cell (IEC) therapies, including benefit verification, pre-certification, concurrent review , appeals , and preparation of cost estimates for… more
- Ascension Health (Wichita, KS)
- …rules and regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Kansas Board of Nursing ... **Details** + **Department:** Utilization Review + **Schedule:** Full time, 36 hrs, Day...+ Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals .… more
- State of Colorado (Denver, CO)
- CDOC Registered Nurse - Part-time - Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4969103) Apply CDOC Registered Nurse - ... and staff instruction; + Assists physicians, physician assistants, and nurse practitioners with minor medical and surgical...Applicant must possess a current, valid license as a Registered Nurse from the Colorado Board of… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4963973) Apply CDOC Registered Nurse ( Nurse ... and staff instruction; + Assists physicians, physician assistants, and nurse practitioners with minor medical and surgical...Applicant must possess a current, valid license as a Registered Nurse from the Colorado Board of… more
- Molina Healthcare (Provo, UT)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of previously ... + Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training,… more
- Sacramento County (Sacramento, CA)
- Supervising Registered Nurse D/CF Print (https://www.governmentjobs.com/careers/sacramento/jobs/newprint/448883) Apply Supervising Registered Nurse ... are at 5:00 pm on: 2/3/25, 4/7/25, 6/2/25, 8/4/25, 10/6/25, 12/1/25 Supervising Registered Nurse - Detention/Correctional Facility is the first level supervisory… more
- Sacramento County (Sacramento, CA)
- …read and understood the above instructions. 02 Select the one box that best describes your Registered Nurse ( RN ) license issued by the State of California. + ... Registered Nurse D/CF (Level I/II) Print...interviewing patients and assisting them in follow-up care; maintaining medical and medication supplies; rendering emergency medical … more
- 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 and ... MaineGeneral's mission of exceptional patient care Job Description: Position: RN Clinical Appeals Specialist Location: Alfond Center...hours/week) Shift: Days, M-F What You'll Do: + Conducts review of patient medical records to determine… more
- Ochsner Health (New Orleans, LA)
- …as it relates to all medical necessity audits. **Education** Required - Registered Nurse Diploma Preferred - Associate's or Bachelor's degree in Nursing ... - Experience in Appeal/Denial Management **Certifications** Required - Current State of Louisiana Registered Nurse ( RN ) License Preferred - Certification in… more