- MedStar Health (Baltimore, MD)
- …and 1-2 years 2 years background/experience in hospital audits preferred Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact ... records of concurrent and retrospective denial activity in conjunction with Case Management support staff. Monitors and tracks denials and appeal results,… more
- UF Health (Gainesville, FL)
- …ensuring quality and regulatory compliance. Qualifications Minimum Education and Experience Qualification: Registered Nurse ( RN ) required or Internal Medical ... and oversight of UF Health Shands CDI Program and Denials Management Program. The CDI program aims...an assigned business purpose as a non-frequent driver. Licensure/Certification/Registration: Registered Nurse ( RN ) or Advanced… more
- Children's Mercy KC (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, and...upon hire One of the following: Licensed RN - Kansas, Registered Nurse … more
- St. Luke's University Health Network (Allentown, PA)
- …communities we serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party ... JOB DUTIES AND RESPONSIBILITIES: + Reviews all Inpatient Retroactive Denials in the Denials Management ...an accredited, professional nursing program. + Must have current RN license to practice in the state of Pennsylvania… more
- University of Michigan (Ann Arbor, MI)
- …for disease processes. + Familiarity with inpatient reimbursement methodologies and denials management . + Strong analytical and problem-solving skills. + ... Denials Prevention/Appeals Specialist Apply Now **Job...This position plays a pivotal role in revenue cycle management by developing and executing robust denials … more
- AdventHealth (La Grange, IL)
- …resolution skills . Teamwork principles **EDUCATION AND EXPERIENCE REQUIRED:** . Associates Degree Nursing or RN Diploma degree . Registered Nurse ( RN ) . ... **LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:** . State of Illinois registered nurse license **LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:**… more
- AdventHealth (Hinsdale, IL)
- …Planning + Conflict management and resolution skills + Teamwork principles + Registered Nurse ( RN ) Required + Certified Case Manager (CCM) Preferred ... transitions, patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the… more
- Baptist Memorial (Memphis, TN)
- Overview Specialist -Denial Mitigation II RN Job Code: 21432 FLSA Status Job Family: FINANCE Job Summary * Position may be filled in Memphis, TN; Jackson , MS The ... Denial Mitigation-Appeal Specialist II RN serves in a key...along to healthcare insurance providers in response to post-claim denials received by BMHCC. Physician Advisor communication may be… more
- St. Luke's University Health Network (Allentown, PA)
- …Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. . ... a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews...and procedure code assignment and MS-DRG/APR-DRG accuracy based on denials or audit findings from government and commercial payers.… more
- HonorHealth (AZ)
- …1 year experience in UR/UM or Case Management Required Licenses and Certifications Registered Nurse ( RN ) State And/Or Compact State Licensure Required ... more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization of...from an accredited NLN/CCNE institution Required Experience 3 years Registered Nurse in an acute care setting.… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. ... molecular pathology, high-cost drug, and off-label drug authorizations. The Clinical Authorization Specialist is also responsible for managing denials related to… more
- UPMC (Pittsburgh, PA)
- … Health Information Administrator OR Registered Health Information Technician (RHIT) OR Registered Nurse ( RN ) + Act 34 *Current licensure either in ... UPMC Corporate Revenue Cycle is hiring a DRG Specialist to work on inpatient auditing within our... (CCS) OR Certified Professional Coder (CPC) OR Certified Registered Nurse Practitioner OR Doctor of Medicine… 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 for evaluating the necessity, appropriateness, and efficiency of hospital services to… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Clinical Documentation Integrity Specialist Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the region's ... be named a Forbes "Best Employer" seven times. Position Summary: The CDI Specialist serves as liaison between the physicians and hospital departments to promote… 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, ... Specialist is responsible for the comprehensive coordination and management of all prior authorization activities specific to cellular therapy services.… more
- St. Mary's Healthcare (Amsterdam, NY)
- …Improvement Specialists obtained prior to hire date or job transfer date. * Registered Nurse credentialed from the New York Board of Nursing obtained ... and coding to maximize documentation, ensure compliance and reduce denials * Works with case management and...Specialist (CCS) credentialed from the American Health Information Management Association (AHIMA) obtained prior to hire date or… more
- Hartford HealthCare (Farmington, CT)
- …now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system. ... Business Office in Newington. *_Position Summary:_* The Revenue Integrity Specialist determines the appropriateness of patient charges, and Charge Description… more
- Penn Medicine (Philadelphia, PA)
- …1500 Market Street Hours: M-F 8a-4:30p, Remote The Health Information Management (HIM) Clinical Documentation Specialist will oversee organization-wide system ... throughout the organization that requires coding and documentation knowledge. Assist Coding Management staff in performing quality audits on coding staff and assist… more
- Catholic Health Initiatives (Omaha, NE)
- …Commonspirit Health Facility Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact patient care and optimize ... experience.** Medical Coding experience is a plus! As our Utilization Review RN , you will be responsible for conducting comprehensive reviews of medical records… more
- Nuvance Health (Danbury, CT)
- …week) ; rotate one weekend per month Summary: The purpose of the Utilization Management Nurse is to support the physician, the interdisciplinary team, and ... Review experience(or a certification ACMA, MCG, Interqual) Required : CT Registered Nurse License Working Conditions: Manual: significant manual skills/motor… more
