- Unknown (Reno, NV)
- …2 years of teaching in nursing programs, and 2 years of direct patient care as a registered nurse are required. The ideal candidate will have a current RN ... student advocacy, policy and procedure development, and maintaining educational partnerships with clinical sites. The Assistant Dean will be a key figure in the… more
- Unknown (Boise, ID)
- …administrative role, 2 years' in teaching within nursing programs, and 2 years' as a registered nurse in direct patient care. The ideal candidate will have a ... responsible for program budgeting, serving as a liaison with clinical sites, and maintaining educational partnerships. Additionally, the role...Dean position must have a completed MSN, a current RN license, and a minimum of 2 years' experience… more
- University of Washington (Seattle, WA)
- …**UW Medicine's Patient Financial Services Department** has an outstanding opportunity for a ** Clinical Appeals and Disputes Nurse .** **WORK SCHEDULE** + ... FTE + 100% Remote + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ...cycle **REQUIREMENTS** + Active licensure to practice as a Registered Nurse in Washington State + Bachelor's… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes ... regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes ...**Education Level:** High School Diploma or GED. **Licenses/Certifications:** + RN - Registered Nurse -… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- Centene Corporation (Austin, TX)
- …State Licensure required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... competitive benefits including a fresh perspective on workplace flexibility. ** RN Strongly Preferred - Compact RN License... requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent… more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... Commercial lines of business. Ensures quality management of the clinical appeal process to reduce the risk of State...goals resulting in the full and fair review of appeals and designed to achieve corporate objectives and advance… more
- LA Care Health Plan (Los Angeles, CA)
- …the ability to manage multiple training initiatives simultaneously. Licenses/Certifications Required Licensed Registered Nurse ( RN ) - Active, current and ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC ...as assigned. Education Required Associate's Degree in Nursing for Registered Nurses Education Preferred Bachelor's Degree in Nursing for… more
- CareFirst (Baltimore, MD)
- …in addition to the required work experience. **Licenses/Certifications Upon Hire Required:** + RN - Registered Nurse - State Licensure And/or Compact ... Corporate Strategic Plan through direction and oversight of the Clinical Medical Claims Reviews, Clinical Appeals and Analysis programs and Quality of… more
- CVS Health (Columbus, OH)
- …with heart, each and every day. **Position Summary** CVS Aetna is seeking a dedicated ** Appeals Nurse Consultant** to join our remote team. In this role, you ... computer. + Responsible for the review and resolution of clinical appeals . + Reviews documentation and interprets...permitted. **Required Qualifications** + Must have active and unrestricted RN licensure in state of residence. + 3+ years… more
- Nuvance Health (Danbury, CT)
- *Description* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within the first 12-24 hours ... 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
- Mount Sinai Health System (New York, NY)
- …(CCM, ACM) or Utilization Management preferred. + 7+ years of experience in clinical acute clinical , utilization management, appeals management or related ... + Ensure timely and appropriate communication with payers for authorization, denials, and appeals . + Collaborate with physicians and clinical teams to ensure… more
- Evolent (Springfield, IL)
- …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- Magellan Health Services (Albuquerque, NM)
- …- Care MgmtCare Mgmt, PT - Physical Therapist, State Licensure - Care MgmtCare Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... care. Oversees utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the...policies and processes. Also oversees the health plans 24/7 Nurse Line program and the clinical management… more
- Houston Methodist (Sugar Land, TX)
- …of care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS** **Required** + RN - Registered Nurse - Texas State Licensure - ... cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or...care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge… more
- Corewell Health (Royal Oak, MI)
- …experience in care management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan License Upon ... criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization… more
- State of Colorado (Denver, CO)
- …(HP III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5183355) Apply Registered Nurse , Health Compliance Inspector Home Care - ... health, safety, and well-being of Colorado communities. As a Registered Nurse ( RN ) Health Professional...such as location and availability Essential Competencies (Required) + RN clinical judgment in the field: Applies… more
- State of Colorado (Denver, CO)
- …III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5190465) Apply Registered Nurse Health Compliance Inspector, Complaints ... Registered Nurse Health Compliance Inspector, Complaints...Section - FAA00731 (HP III RN ) Salary $80,916.00 Annually Location Denver, CO Job Type… more
- Corewell Health (Dearborn, MI)
- …experience in care management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan Upon Hire ... criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization… more
- State of Colorado (Golden, CO)
- Registered Nurse I, RN I - Campus at Lookout Mountain, Youth Services Center - Golden Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5185059) Apply Registered Nurse I, RN I - Campus at Lookout Mountain, Youth Services Center… more
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