- RestoraCare Staffing (Houston, TX)
- RestoraCare Staffing is seeking a Registered Nurse (RN) Case Management for a nursing job in Houston, Texas.Job Description & RequirementsSpecialty: Case ... Current and valid license to practice as a Registered Nurse in the state of Texas or Current and...within two (2) years of hire into the Case Manager position. Experience / Knowledge / Skills:Three (3) years… more
- CareFirst (Owings Mills, 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 ...And/or Compact State Licensure + CCM - Certified Case Manager + LNCC - Legal Nurse Consultant… more
- Trinity Health (Farmington Hills, MI)
- …claim is paid/settled in the most timely manner possible: + Supports Supervisor Clinical Payment Resolution or Manager Clinical /Coding Payment Resolion with ... **Description:** **POSITION PURPOSE** Work Remote Position (Pay Range: $39.8218-$59.7327) Applies clinical and comprehensive payer and appeals knowledge in… more
- HCA Healthcare (Nashville, TN)
- …for performing daily appeals follow-up, monitoring denials trends/issues and assisting the Clinical Appeals Manager with training of the appeals ... join an organization that invests in you as a Clinical Appeals Team Lead? At Parallon, you...policies and procedures are followed. + Meets with the Manager regularly to effectively communicate and resolve issues, set… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical quality oversite. This ... position reports to the Clinical Program Manager . This job description is not designed to cover...within managed care setting. + 3+ years' experience in clinical nurse setting preferred. + Grievance experience… more
- LA Care Health Plan (Los Angeles, CA)
- …the needs of LA Care's culturally diverse membership. The position supports the A&G Clinical Manager . This role also assists the A&G Leadership in identification ... Supervisor, Appeals and Grievances Clinical Operations RN...Must be able to work independently. Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California License… more
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES...clinical guidelines; refers questionable cases to the CM Manager or physician advisor for determination. 3. Collaborates and… more
- UNC Health Care (Chapel Hill, NC)
- …unique communities we serve. RN Utilization Manager position specifically for a Utilization Manager / Clinical Appeals Nurse . This person is based at ... through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff… more
- Baystate Health (Greenfield, MA)
- …home to **Baystate Franklin Medical Center** is looking for a **Per Diem** **Registered Nurse (RN), Case Manager ** to join our Hospital Case Management team in ... Recruiter** **###@baystatehealth.org** **Summary:** The Utilization Management Specialist (UMS)/Hospital Case Manager (HCM) is a Registered Nurse (RN)… more
- Actalent (Sacramento, CA)
- …or claim denial. The Medi-Cal Appeals and Grievances RN will report to the Appeals and Grievances Manager . + In this role you will perform accurate and ... Hiring a Registered Nurse for a great hospital FULLY REMOTE!! MUST...timely clinical review of Member-initiated appeals . + The...timely clinical review of Member-initiated appeals . + The RNs perform first level appeal reviews… more
- State of Colorado (Denver, CO)
- …and level of staffing during own shift and proximal shifts. In collaboration with Nurse Manager and treatment team, recommends a change in program scheduling to ... During specific shifts, functions in the role of Charge Nurse and provides clinical and administrative supervision...coaching and direction in the moment, and recommends to Nurse Manager strategies to improve staff skills… more
- State of Colorado (Sterling, CO)
- CDOC Registered Nurse - Part-time - Sterling Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4508889) Apply CDOC Registered Nurse - ... Sterling, CO Job Type Part Time Job Number CAA Nurse I SCF 05/2024 Department Department of Corrections Division... I SCF 05/2024 Department Department of Corrections Division Clinical and Correctional Services Opening Date 05/15/2024 Closing Date… more
- State of Colorado (CO)
- …CAA Nurse III 2/2024 Department Department of Corrections Division Clinical and Correctional Services Opening Date 02/08/2024 Closing Date 6/30/2024 4:00 PM ... CDOC Nurse Supervisor Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4383689) Apply CDOC ...larger complex facility, or a supervisor in a specialized clinical treatment unit. This position may be required to… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4394165) Apply CDOC Registered Nurse ( Nurse I) ... $7,225.00 Monthly Location Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 2/2024 Department Department of Corrections Division Clinical and… more
- International Medical Group (Indianapolis, IN)
- …outpatient management of assistance cases. + Knowledge of the Non-certification process and Appeals process including logs and time frames. + Participate in the on ... and/or seminars. + Support and participate in Quality Management activities. + Utilize clinical support tools as indicated. + Maintain a working knowledge of the any… more
- Pacific Medical Centers (Seattle, WA)
- …appeals for presentation. Decision maker for all post service, network and benefit appeals . Acts as second level manager for grievances. Works with patients ... appeals for presentation. Decision maker for all post-services, network and benefit appeals . Acts as second-level manager for grievances. Works with patients… more
- Universal Health Services (Richmond, VA)
- … Appeals Manager to coordinate the operational activities of the nurse auditor's workflow in the Appeals department. Key Responsibilities include: + ... Atlantic Region CBO is seeking a dynamic and talented Nurse Auditor Team Lead. The Nurse Auditor...auditors by answering questions/concerns and provide guidance on difficult clinical cases. + Review and/or create daily, weekly and… more
- WesleyLife (Adel, IA)
- …as the people whose lives they touch. **A Typical Day for a Home Health Clinical Manager with** **WesleyLife at Home/Home Health:** + Mentors team members to ... day-to-day work life, consider one of our roles. From clinical positions to hospitality roles to administrative positions, we...preferred. + One year of full-time experience as a nurse case manager in home health or… more
- LifePoint Health (Rutherfordton, NC)
- …Veteran* **Job:** **Case Management/Social Services* **Organization:** ** **Title:** * Clinical Case Manager * **Location:** *NC-Rutherfordton* **Requisition ID:** ... services to communities. Duke LifePoint combines Duke's unparalleled expertise in clinical excellence and quality care with LifePoint's extensive resources and… more
- City and County of San Francisco (San Francisco, CA)
- …in the Adult Immunization and Travel Clinic as required. Under general supervision of the Nurse Manager , the 2830 Public Health Nurse performs the following ... County of San Francisco is accepting applications for permanent Clinical 2830 Public Health Nurse positions. Rather...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
