- SUNSHINE ENTERPRISE USA LLC (Orange, CA)
- …of the position such as those listed above is also qualifying. Preferred Qualifications Active Registered Nurse ( RN ) license to practice in the state of ... Job Description Grievance & Appeals Nurse Specialist At Sunshine Enterprise USA, we're not just a company; we're a community of dedicated professionals committed… more
- University of Washington (Seattle, WA)
- …Medicine UW Medical Center-Montlake - Rheumatology Clinic has an outstanding opportunity for a Registered Nurse . WORK SCHEDULE Full time / 40 hours per week Day ... staff. This position will be the only full time RN on the team. PRIMARY JOB RESPONSIBILITIES Conducts in-basket...inpatient hospital setting Active licensure to practice as a Registered Nurse in Washington State BLS ABOUT… more
- 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 ... - $2,890 Position Overview: We are seeking an experienced Registered Nurse ( RN ) specializing in...established escalation protocols when criteria are not met Facilitate appeals and initiate required notices (eg, HINN, discharge … more
- NYULMC (New York, NY)
- …Position Summary: We have an exciting opportunity to join our team as a Registered Nurse , Care Manager, Day Shift. In this role, the successful candidate ... announcements, etc. Minimum Qualifications: To qualify you must have a Professional Registered Nurse in New York State with current registration. Education:… more
- Tenet Health (West Palm Beach, FL)
- …reporting of data for other departments. Qualifications EDUCATION Graduate of Registered Nurse Program EXPERIENCE 2 years acute care RN experience LICENSE ... Registered Nurse CERTIFICATION BLS (AMERICAN HEART ASSN) #LI-RS1 Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law,… more
- NavitsPartners (Hyannis, MA)
- Job Title: Registered Nurse - Case Management (Travel) Location: Hyannis, MA Job Type: Contract Pay: $70 - $80.03/hour | $3,201/week (Travel Rate) Schedule: 40 ... Weekend | Rotating Holidays Job Overview We are seeking a highly skilled and motivated Registered Nurse - Case Manager (Travel) to join a dynamic care team in… more
- Beth Israel Lahey Health (Plymouth, MA)
- …team to assess and improve the denial management, documentation, and appeals process. Collaborates with UR Manager and/or physician advisor regarding cases ... the job that may reasonably be required. Education/Experience Required: Current MA RN licensure Bachelor's Degree in Nursing or advanced degree in healthcare… more
- Pioneer Healthcare (Salinas, CA)
- …MC - Salinas, CA Job Description: If you want to make a significant impact as a Registered Nurse - Case Manager in Salinas, CA this position might be what you ... , and approvals for necessary medical services and treatments. Qualifications: CA Registered Nurse license Associate Degree in Nursing (ADN) or Bachelor… more
- UofL Health (Louisville, KY)
- …Health experience (required for positions at Peace Hospital) Licensure: *Active Kentucky Registered Nurse License or compact license with privileges to work ... serve through compassionate, innovative, patient-centered care. The Utilization Review RN performs activities which support the Utilization Management functions.… more
- University Hospitals (Beachwood, OH)
- …guidelines. (Required proficiency) CM software proficient. (Preferred proficiency) Licenses and Certifications Registered Nurse ( RN ), Ohio and/or Multi State ... reimbursement Perform timely and accurate review, denial communications and construct appeals , including remaining current with regulatory / payer and internal… more
- University of Iowa Hospitals & Clinics (Iowa City, IA)
- Description The University of Iowa Healthcare Downtown Campus, is looking for a Nurse Clinician to functions as a clinical nurse expert and clinical coordinator ... Participate in the resolution of retrospective reimbursement issues, including appeals , third-party payer certification, and denied cases. Provide clinical… more
- Jaz Staffing Agency (Houston, TX)
- …of Social Work program. Licenses/Certifications: Current and valid license to practice as a Registered Nurse in the state of Texas or Current and valid license ... per case, excess days, resource utilization, readmission rates, denials and appeals . Uses data to drive decisions and plan/implement performance improvement… more
- Bryan Health (Lincoln, NE)
- …12. Ability to maintain regular and punctual attendance. EDUCATION AND EXPERIENCE: Current Registered Nurse licensure from the State of Nebraska or approved ... screening, insurance verification for benefits, medical necessity reviews, denial and appeals and coordinates admissions with the admitting physician and staff. Will… more
- Clarke County Hospital (Osceola, IA)
- …surgical services departments, staff development, front line staff orientation and nurse residency program that includes staff clinical competencies, standards of ... including but not limited to DNV, Department of Inspections and Appeals Critical Access Hospital Regulations, professional nursing standards of care/practice and… more
- Elevance Health (Tampa, FL)
- ** Nurse Appeals - Medicare** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... an accommodation is granted as required by law. The ** Nurse Appeals - Medicare** is responsible for...would provide an equivalent background. + Current active unrestricted RN license to practice as a health professional within… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Appeals Nurse Reviewer is responsible for applying sound clinical judgement to ... integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve as a...to assist with medical necessity determinations. Key Qualifications: + Registered Nurse with an active unrestricted professional… more
- R1 RCM (Boise, ID)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Nurse ** , you will help our hospital clients by ... **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review...at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position,… more
- Molina Healthcare (Midvale, UT)
- **JOB DESCRIPTION** _For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state of UTAH or have a compact license._ _This ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …more **Description** We're seeking under the direction of the **Utilization Management Appeals Professional, Registered Nurse ** is responsible for managing ... **MINIMUM QUALIFICATIONS** : + License - Must have a valid, active unencumbered Registered Nurse license or temporary permit approved by the Georgia Licensing… more
- Intermountain Health (West Valley City, UT)
- …medical necessity of the admission. Reports to the Director of Audit and Appeals in the Revenue Integrity Department. ESSENTIAL DUTIES AND RESPONSIBILITIES 1. Uses ... write up clinical reviews for insurance audits and governmental insurance appeals using supporting documentation. 2. Assesses the appropriateness of clinical appeal… more
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