- St. Luke's University Health Network (Allentown, PA)
- …communities we serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- Cognizant (Harrisburg, PA)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...as well as timely filing deadlines and processes. . Review clinical denials including but not limited… more
- AmeriHealth Caritas (Philadelphia, PA)
- …process, preferably within a managed care organization **Licensure:** + Current and unrestricted Registered Nurse ( RN ) licensure or compact state licensure ... **Role Overview: ;** The Clinical Appeals Reviewer is responsible for...appeals , ensuring compliance with all regulatory milestones + Review medical records to identify Hospital-Acquired Conditions (HAC), ensure… more
- Penn State Health (Hershey, PA)
- …executive orders that prohibit or outlaw discrimination._ **Union:** Non Bargained **Position** Clinical Appeals Nurse - Revenue Integrity Process ... + Bachelor's degree in Nursing required. + Currently licensed to practice as a Registered Nurse by state of employment or holds a multistate RN… more
- Evolent (Harrisburg, PA)
- …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...work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators… more
- Highmark Health (Pittsburgh, PA)
- **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care and manages ... and contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials/ appeals and retrospective payer audit denials.… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …as necessary collaboration/supervision agreements with Advance Practice Professionals (Certified Registered Nurse Practitioners or Physician Assistants) and ... and Statistical Manual of Mental Disorders, written treatment orders, admissions on-call review for all legal commitment status documents and review and… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …as necessary collaboration/supervision agreements with Advance Practice Professionals (Certified Registered Nurse Practitioners or Physician Assistants) and ... history and physical examination, either written or dictated. This includes a review of the immunization status, allergies, past history, family history and… more