- 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 ... alignment with MaineGeneral's mission of exceptional patient care Job Description: Position: RN Clinical Appeals Specialist Location: Alfond Center for… more
- Molina Healthcare (Tacoma, WA)
- … decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making...these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- Ochsner Health (New Orleans, LA)
- …- Experience in Appeal/Denial Management **Certifications** Required - Current State of Louisiana Registered Nurse ( RN ) License Preferred - Certification in ... Health and discover your future today!** This job applies clinical expertise as well as knowledge of utilization and...relates to all medical necessity audits. **Education** Required - Registered Nurse Diploma Preferred - Associate's or… more
- State of Colorado (Denver, CO)
- CDOC Registered Nurse - Part-time - Denver Print...Yes + No 06 Do you possess an active RN license issued by an Enhanced Nurse Licensure ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4945982) Apply CDOC Registered Nurse - Part-time - Denver Salary...Colorado? If so, what state issued your license? 07 Nurse Licensure Compact: If appointed to an RN… more
- City and County of San Francisco (San Francisco, CA)
- …of experience working as a Registered Nurse SPECIALTY REQUIREMENTS: + Clinical Documentation Specialist (CCDS) certification + At least 3 years of ... LICENSE: Possession of a valid permanent/temporary (including interim permit) California Registered Nurse License (**IMPORTANT: Be sure to include your… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print...RN license. 07 Do you possess an active RN license issued by an Enhanced Nurse Licensure ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4762850) Apply CDOC Registered Nurse ( Nurse I) Salary $7,442.00 Monthly Location Statewide,… more
- Baptist Memorial (Memphis, TN)
- …in a payer hearing or clinical meeting when indicated. The Denial Mitigation-Appeal Specialist II RN may have the opportunity to work remotely after 90 days ... Overview Specialist -Denial Mitigation II RN Job Code:...determine next steps. In accordance with the guidelines, the Specialist compiles an appeal along with pertinent clinical… more
- Baptist Memorial (Memphis, TN)
- …in a payer hearing or clinical meeting when indicated. The Denial Mitigation-Appeal Specialist II RN may have the opportunity to work remotely after 90 days ... Overview Specialist -Denial Mitigation II RN Job Code:...determine next steps. In accordance with the guidelines, the Specialist compiles an appeal along with pertinent clinical… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks ... preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending....an accredited, professional nursing program. + Must have current RN license to practice in the state of Pennsylvania… more
- City and County of San Francisco (San Francisco, CA)
- …( RN ) license issued by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a valid Clinical ... will provide consultation, education, and advanced practice support to registered nurses, public health nurses, and other clinical...college or university; AND + License and Certification: + Registered Nurse License: Possession of a valid… 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, ... The Cell Therapy Clinical Authorization Specialist is responsible for...waivers and non-covered services. + Collaborate closely with physicians, nurse coordinators, and interdisciplinary clinical teams to… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... **Job Summary** The Clinical Utilization Review Specialist is responsible...conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate… more
- Independent Health (Buffalo, NY)
- …(RHIA), Registered Health Information Technician (RHIT), Certified Clinical Documentation Specialist (CCDS), American Health Information Management ... coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with… more
- Medical Mutual of Ohio (OH)
- …+ Current, unrestricted license in the state of Ohio in one of the following: Registered Nurse ( RN ), Licensed Practical Nurse (LPN), Licensed Independent ... management on implementation plans. Develops, delivers and evaluates cross-functional clinical , non- clinical , and systems training; new employee orientation;… more
- Trinity Health (Des Moines, IA)
- …health administration or related field required. + Iowa licensure as a Registered Nurse . + Member of a professional healthcare organization.Demonstrated ... **Employment Type:** Full time **Shift:** Day Shift **Description:** The purpose of the Clinical Integration Specialist is to assist and support the Director in… more
- CaroMont Health (Gastonia, NC)
- …for promoting and monitoring safe, high-quality, cost-effective healthcare with the best clinical outcomes possible. Provide physician and nurse education to ... and reporting. Perform data collection and analysis, trend identification for assigned clinical outcomes, and present this data at the appropriate meetings as… more
- BriteLife Recovery (Englewood, NJ)
- …clinical information and advocating for appropriate levels of care. The UR Specialist works closely with clinical staff, admissions, medical providers, and ... What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible for… more
- PeaceHealth (Vancouver, WA)
- **Description** **PeaceHealth is seeking a Referral/Pre-Auth Specialist - Remote (OR, WA, AK) for a Full Time, 0.80 FTE, Day position.** The salary range for this ... receiving, processing and documenting referral or prior authorization requests from the clinical areas. Provides customer service and support for the clinical … more
- Children's Mercy Kansas City (Kansas City, MO)
- …Utilization Review, and Performance Improvement Leadership + One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required ... Nurse Case Managers, Social Workers, and Utilization Review specialist team members and support staff + Analyzes, evaluates,...upon hire + One of the following: Licensed RN - Kansas, Registered Nurse … more