- …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help our ... position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct...at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position,… 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
- R1 RCM (Detroit, MI)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** +...external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + An active CCS,… more
- Commonwealth Care Alliance (Boston, MA)
- …and sound clinical judgment in reviewing medical records and writing appeals . + Participate in telephonic Administrative Law Judge Hearings and present oral ... 011540 CCA- Appeals & Grievances **Position Summary:** Investigate and resolve...audits in preparation of regulatory site visits. + Provide clinical care to members via telehealth technologies (video, chat,… more
- State of Colorado (Denver, CO)
- …(HP III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4966056) Apply Registered Nurse Health Compliance Inspector Home Care - ... Registered Nurse Health Compliance Inspector Home Care -...FAA00601 (HP III RN ) Salary $72,336.00 Annually Location Denver, CO Job Type Full Time… more
- State of Colorado (Denver, CO)
- …III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4966096) Apply Registered Nurse Health Compliance Inspector, Nursing ... Registered Nurse Health Compliance Inspector, Nursing...Facilities - FAA00392 (HP III RN ) Salary $72,336.00 Annually Location Denver, CO Job Type… more
- Select Medical (Los Angeles, CA)
- …UCLA and Select Medical Century City / Los Angeles, CA Case Manager (CM) - Registered Nurse ( RN ) or Social Worker (LCSW) **Per Diem (variable schedule)** ... valid state licensure in Social Work required or Current state licensure as a Registered Nurse required. + Previous experience in Case Management and Discharge… 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/4969103) 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
- 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/4963973) Apply CDOC Registered Nurse ( Nurse I) Salary $7,442.00 Monthly Location Statewide,… more
- Sacramento County (Sacramento, CA)
- …read and understood the above instructions. 02 Select the one box that best describes your Registered Nurse ( RN ) license issued by the State of California. + ... Registered Nurse D/CF (Level I/II) Print...+ Use and care of medical equipment used in clinical and infirmary settings + Basic medical indications of… more
- City and County of San Francisco (San Francisco, CA)
- …AND EXPERIENCE: At least one (1) year of experience working as a Registered Nurse SPECIALTY REQUIREMENTS: + Clinical Documentation Specialist (CCDS) ... LICENSE: Possession of a valid permanent/temporary (including interim permit) California Registered Nurse License (**IMPORTANT: Be sure to include your… more
- Centene Corporation (Sacramento, CA)
- …State Licensure required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... a fresh perspective on workplace flexibility. This position requires RN California Licensure and for candidates to have a... requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent… more
- State of Colorado (Pueblo, CO)
- …the situation. 10 A requirement of the position is that you possess and maintain a VALID Registered Nurse ( RN ) License issued by the State of Colorado or any ... Registered Nurse III- Staffing Office CMHHIP...patient units at CMHHIP. Duties in this position include: Management/ Clinical Direction & Supervision: + Performs as the Staffing… more
- Atlantic Health System (Union, NJ)
- …quality patient care. + Information Management: Utilizes computer systems as required. + The Registered Nurse ( RN ) in the ambulatory practices functions as ... forms. The ideal candidate will be proficient in initiating and managing clinical appeals , including the collection and submission of supporting documentation.… more
- State of Colorado (Denver, CO)
- Registered Nurse I-Colorado Mental Health Hospital in Fort Logan-Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4969227) Apply ... Registered Nurse I-Colorado Mental Health Hospital in...During specific shifts, functions in the role of Charge Nurse and provides clinical and administrative supervision… 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
- KidsPeace Childrens Hospital (Varina, IA)
- The Certified Registered Nurse Practitioner (CRNP) is responsible for overseeing the psychiatric needs of children, adolescents, and/or adults, with primary ... and maintain a valid, current and unrestricted license to practice as a Certified Registered Nurse Practitioner. Must be credentialed to serve on the Medical… 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 ... hiring a Manager who is responsible for providing day to day management of the RN Care Managers in the department. Pay Range: $95,000 plus based on education and… more
- Veterans Affairs, Veterans Health Administration (Hines, IL)
- …of the role is to complete concurrent reviews of medical records and prepare clinical appeals (when appropriate) on medical necessity, level of care, and length ... Summary The Utilization Management (UM) Consultant is a registered professional nurse , qualified by education...officers, Emergency Department (ED) staff, and Bed Management. The nurse is responsible for applying clinical skills… more
- CareFirst (Baltimore, MD)
- …experience is required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact ... programs lines of business. Ensures quality management of the clinical appeal process to reduce the risk of State...for Care Management. We are looking for an experienced RN leader in the greater Baltimore metropolitan area who… more