- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- CommonSpirit Health (Centennial, CO)
- …resources to help you flourish and leaders who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison ... need the following: Required Education: BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive… more
- Nuvance Health (Danbury, CT)
- …Days, Evenings, Nights available* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within ... 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
- McLaren Health Care (Mount Pleasant, MI)
- …outcomes and fulfills the obligation and responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer ... + Certified Medical Coder, Certified in Healthcare Compliance, Certified Coding Specialist , or Certified Clinical Documentation Specialist certifications more
- Beth Israel Lahey Health (Cambridge, MA)
- …to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality data by ... reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review...prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for… more
- Houston Methodist (Sugar Land, TX)
- …management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of care for ... and billing processes, managed care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of CPT and ICD… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- Clark County, NV (Las Vegas, NV)
- YOUTH & ADULT INTERVENTION SPECIALIST I/II Print (https://www.governmentjobs.com/careers/clarkcounty/jobs/newprint/5146174) Apply YOUTH & ADULT INTERVENTION ... SPECIALIST I/II Salary $32.77 - $52.32 Hourly Location Clark...Vegas, NV Job Type PERMANENT Job Number 30433 Department Clinical Services Division Fam Clinic Svcs Opening Date 11/25/2025… more
- Fairview Health Services (St. Paul, MN)
- …the development of denial reports and other statistical reports. + Collaborates with Clinical Denials Nurse Specialist and Leadership in high-dollar claim ... **Job Overview** The Inpatient Coding Denials Specialist performs appropriate efforts to ensure receipt of...records and coding guidelines to formulate coding arguments for appeals and/or coding guidance for potential re-bills. Maintains a… more
- UNC Health Care (Kinston, NC)
- … denials for validity and probability to overturn, proactively gathers required clinical documentation and formulates appropriate appeals . Coordinates with the ... win rates. 12. Assists in documentation review in the clinical documentation specialist role when needed. Working...preferred. + **EXPERIENCE** + Minimum 3-5 years of applied clinical experience as a Registered Nurse required.… more
- Molina Healthcare (NE)
- …Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory ... our Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have strong organizational… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5123731) Apply CDOC Registered Nurse ( Nurse I) ... $10,627.00 Monthly Location Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 10/2025 Department Department of Corrections Division Clinical and… more
- State of Colorado (Sterling, CO)
- Nurse Supervisor - Sterling Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5123947) Apply Nurse Supervisor - Sterling Salary $8,369.00 - ... $11,717.00 Monthly Location Sterling, CO Job Type Full Time Job Number Nurse III 30492 10/2025 Department Department of Corrections Division Clinical and… more
- State of Colorado (Limon, CO)
- CDOC - (LPN) LICENSED PRACTICAL NURSE - (LIMON) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5111679) Apply CDOC - (LPN) LICENSED PRACTICAL ... NURSE - (LIMON) Salary $4,025.00 - $5,636.00 Monthly Location...plans, employs infection control measures, provides referral to appropriate Clinical Services staff for new arrivals, crisis intervention, interviews… more
- Hartford HealthCare (Farmington, CT)
- …. Prepare, document and submit appeals for DRG denials, ensuring appeals are well-supported with clinical evidence, coding guidelines, and regulatory ... and appeals preferred. **Licensure, Certification, Registration** * Active Registered Nurse license from the State of Connecticut * Certified Clinical … more
- Molina Healthcare (Long Beach, CA)
- …License must be active and unrestricted in state of practice. * Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager ... strategy to provide quality and cost-effective member care. The **Delegation Oversight Nurse ** is responsible for ensuring that Molina Healthcare's UM delegates are… more
- Cummins Behavioral Health Systems Inc. (Avon, IN)
- …possess Indiana state licensure as a Registered Nurse with certification as a Clinical Nurse Specialist or Nurse Practitioner with prescriptive ... place. * If being part of a learning organization appeals to you, get in touch with us. *...throughout central and west central Indiana. The Advanced Practice Nurse , under the supervision of a Staff Psychiatrist, will… more
- Cedars-Sinai (Beverly Hills, CA)
- …care. Use Milliman and Interqual guidelines as necessary. + Collaborates with clinical teams and practices to ensure synchronization of sub-areas' operations to ... Investigates, processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate policy. + Begins… more
- Garnet Health (Middletown, NY)
- …and rural life, we invite to make your career home with us as a CLinical Documnetaion Specialist on our CDI team at/in Garnet Health Medical Center. ... of DRG and Coding appeal process Required Certification/Registration: * Certified Clinical Documentation Specialist (CCDS) credentialed within 6 months *… more
- State of Colorado (Chaffee County, CO)
- …diagnosis, and treatment for acute, chronic, and emergency care for inmates in the clinical setting, which could include a clinic, an infirmary, or a special needs ... and other related laboratory tests; + Follow the CDOC clinical services standards and procedures, protocols, guidelines, or policies...must possess current, valid licensure as an Advanced Practice Nurse / Nurse Practitioner from the Colorado… more
Related Job Searches:
Appeals,
Appeals Nurse,
Appeals Specialist,
Clinical,
Clinical Appeals Nurse,
Clinical Appeals Specialist,
Clinical Nurse,
Nurse,
Nurse Specialist,
Specialist