- UC Davis Health (Sacramento, CA)
- …upload license and/or certification if required of the position Valid California Registered Nurse License without restriction Graduation from an accredited ... The Clinical Case Manager integrates and coordinates utilization management,...patients who lack medical necessity for acute hospital admission, denials for continued stays, and other factors affecting appropriate… more
- Sonder Health Plans, Inc. (Atlanta, GA)
- …with Medicare Advantage/Commercial populations, utilization management experience and acute clinical nursing experience *Active Georgia Registered Nursing ... Health Plans is looking for a full-time Utilization Management Nurse to make sure our health services are administered...of this position is to provide operational support and clinical expertise in the areas of health care services,… more
- Adventist HealthCare (Silver Spring, MD)
- …preferred *Minimum of 1-3 years clinical experience required *Licensed as Registered Nurse *Preferably prior case management or discharge planning experience ... Planner, you will: *Complete comprehensive psycho-social assessment and review of clinical needs of patients with focus on patient's requirements as they… more
- Guidehouse (Huntsville, AL)
- …None **Clearance Required** **:** None **What You Will Do** **:** The **R** **emote** ** Clinical Denials RN** is responsible for review, analysis and appeal of ... **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:**...clinical denials from insurance companies and third-party payers. This role… more
- Catholic Health Initiatives (Little Rock, AR)
- …State of Arkansas Bachelors Of Nursing Or related healthcare field Minimum three (3) years clinical experience as Registered Nurse (RN) 5 years of RN ... The RN has an integral role within the revenue cycle by providing clinical expertise in the denials management process. The Denials RN performs a root cause… more
- Trinity Health (Hartford, CT)
- …in development of action plans to ensure goals are met **Minimum Qualifications** + Registered Nurse (RN) or Licensed Vocational Nurse / Licensed Practical ... of patient access, revenue cycle and denial management functions; technical and clinical denials areas, such as medical necessity, eligibility issues, no… more
- Children's Mercy Kansas City (Kansas City, MO)
- …per contracts for medically appropriate level of care. Manages concurrent clinical denials through completion of verbal reconsideration process. Works ... children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes ...+ One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon… more
- HCA Healthcare (Nashville, TN)
- …want to join an organization that invests in you as a Utilization Review Services Registered Nurse ? At Parallon, you come first. HCA Healthcare has committed up ... We are looking for a dedicated Utilization Review Services Registered Nurse like you to be a...as needed for authorization procurement and mitigation of concurrent denials . This involves assessing the medical record for appropriateness… more
- Texas A&M University System (College Station, TX)
- Job Title Registered Nurse II - Prior Authorization & Referral Agency Texas A&M University Health Science Center Department University Health Services Proposed ... and team-based health care delivery. What we want The Registered Nurse II-Prior Authorization and Referral, under...are denied. + Collaborate with providers to gather necessary clinical documentation and address denials or escalations.… more
- R1 RCM (Boise, ID)
- …appeals.Represent clients at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay ... analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help...clients by serving as an expert on appeals and denials management where claims were denied by either governmental… 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 ... through appropriate administrative and medical channels to avoid third party payer denials . + Maintains awareness of all concurrent denials through interaction… more
- Crouse Hospital (Syracuse, NY)
- …requirements and contractual agreements. Manager, Care Coordination Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree + Five ... Managers in the department, including Utilization Management, Discharge Planning and Denials and Appeals functions. + Assessing workflow related to readmission… more
- Intermountain Health (Murray, UT)
- **Job Description:** The Nurse Case Manager utilizes clinical expertise and critical thinking skills to develop and implement a plan of care that provides cost ... denial prevention. Proactively intervenes with payers to prevent inpatient denials . Performs retroactive reviews on discharged patients as assigned....nurse practices. - and - Three years of clinical nursing experience. - and - RNs hired or… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a **Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, Barksdale ... One year of experience in Utilization Management is required. Full time employment as a registered nurse within the last 36 months is mandatory. Six years of … more
- AdventHealth (La Grange, IL)
- …AND EXPERIENCE REQUIRED:** . Associates Degree Nursing or RN Diploma degree . Registered Nurse (RN) . Two (2) years of medical/hospital nursing experience ... **LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:** . State of Illinois registered nurse license **LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:**… more
- Bon Secours Mercy Health (Warren, OH)
- …* Be mindful of revenue cycle components including scheduling, registration, clinical coverage/treatment, documentation, billing, collections, and denials . * ... effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Summary of Primary Function/General Purpose of… more
- AdventHealth (Hinsdale, IL)
- …Discharge Planning + Conflict management and resolution skills + Teamwork principles + Registered Nurse (RN) Required + Certified Case Manager (CCM) Preferred + ... Manager ensures efficient and cost-effective care through appropriate resources monitoring, and clinical care escalations. The RN Care Manager is under the general… more
- Beth Israel Lahey Health (Plymouth, MA)
- … clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient. ... or advanced degree in healthcare preferred. + Three years recent, broad clinical experience in the hospital setting + Experience with utilization management within… more
- AdventHealth (Altamonte Springs, FL)
- …Degrees without out-of-pocket tuition expense) *For eligible positions* + Nursing Clinical Ladder Program*For eligible positions* + Whole Person Well-being and ... Manager ensures efficient and cost-effective care through appropriate resources monitoring, and clinical care escalations. The RN Care Manager is under the general… more
- AdventHealth (Winter Garden, FL)
- …Degrees without out-of-pocket tuition expense) *For eligible positions* + Nursing Clinical Ladder Program*For eligible positions* + Whole Person Well-being and ... Manager ensures efficient and cost-effective care through appropriate resources monitoring, and clinical care escalations. The RN Care Manager is under the general… more
