- Elevance Health (Costa Mesa, CA)
- ** Nurse Appeals Lead ( RN )** **Location** : This role requires associates to be in-office **1-2 days per week** , fostering collaboration and ... considered. **Shift:** Monday to Friday from 8:00am-5:00pm **PST** The ** Nurse Appeals Lead ** is responsible...provide an equivalent background. + Current active valid unrestricted RN license to practice as a health professional within… more
- State of Colorado (Golden, CO)
- Registered Nurse I, RN I...records for medication errors and reporting them to the Lead Medical or Mid-Level Provider in charge, including lack of ... Mountain, Youth Services Center - Golden Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4935383) Apply Registered Nurse I, RN I -… more
- Elevance Health (Tampa, FL)
- ** Nurse Appeals ** **Location** : **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... skill development. **Expected Work Hours: Monday-Friday OR Tuesday-Saturday; 8am-5pm** The ** Nurse Appeals ** is responsible for investigating and processing… more
- Sacramento County (Sacramento, CA)
- …of Supervising Public Health Nurse : + Must possess and maintain a current Registered Nurse License and Public Health Nurse Certificate issued by the ... Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days...to this class must possess and maintain a current Registered Nurse license and Public Health … more
- Sharp HealthCare (La Mesa, CA)
- …Status** Per Diem **Shift** Day **FTE** 0 **Shift Start Time** **Shift End Time** California Registered Nurse ( RN ) - CA Board of Registered Nursing; ... care nursing experience or case management experience. + California Registered Nurse ( RN ) - CA...policies; work calmly and respond courteously when under pressure; lead , supervise, teach, collaborate and accept direction.The RN… more
- Trinity Health (Des Moines, IA)
- …Denials management. **MINIMUM KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:** + Current licensure as a registered nurse in the State of Iowa. + Five (5) years ... Family! We are looking to hire a Utilization Review RN ! Responsible for the review of inpatient and outpatient...Collaborates with MercyOne Post Denials team to determine potential appeals or downgrades and documents in STAR. + Ensures… more
- Nuvance Health (Danbury, CT)
- …in nursing, health administration, or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience ... of care, prevent readmissions, and optimize patient outcomes. * *Denials Management & Appeals :* * *Root Cause Analysis:* Lead a specialized team to thoroughly… more
- Centene Corporation (Tacoma, WA)
- …or Healthcare Administration required **Experience in Behavioral Healthcare field preferred:** Registered Nurse ( RN ) certification, Licensed Mental Health ... Care or Healthcare Administration required. Experience in Behavioral Healthcare field required. Registered Nurse ( RN ), Licensed Clinical Social Worker… more
- Trinity Health (Maywood, IL)
- …1-2 years **Licensure/Certifications:** **Required:** CPR (Cardiopulmonary Resuscitation) Current Registered Nurse License State of Illinois **Preferred:** ... **Employment Type:** Full time **Shift:** **Description:** The Lead Case Manager Position reports to the Manager... Case Manager Position reports to the Manager of Nurse Care Management. The specific duties include: Recruiting, interviewing,… more
- State of Colorado (Denver, CO)
- Lead Mid-Level Provider - Gilliam Youth Services Center - Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4920655) Apply Lead ... per requirements in applicable cases. Serves as the facilities' lead decision maker during emergency medical situations. Approves and...interns. Point of contact for the local schools for RN , NP or PA students. Facilitates regular staff meetings.… more
- State of Colorado (Denver, CO)
- …Rights Minimum Qualifications: Education/Licensure/Certification/Experience: + Current, valid licensure as a Registered Nurse from the Colorado Board of Nursing ... health care including physical, psychiatric, and dental maintenance. The Lead Mid Level Provider practices as a clinician and...or any state participating in the Enhanced Nurse Licensure Compact (eNLC) + And four (4) years… more
- Sacramento County (Sacramento, CA)
- …Possession of a valid license from the State of California to practice as a Registered Nurse , Vocational Nurse or Psychiatric Technician AND Either: 1. Two ... Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days...California license you currently hold to practice in: + Registered Nurse + Vocational Nurse … more
- Presbyterian Homes and Services (Roseville, MN)
- …effective care plan development and management for your assigned region. Qualifications + Registered nurse with current licensure the State Board of Nursing in ... + Audit RUG grouper/MDS end splits, review all expedited appeals and ALJ level appeals . Perform concurrent...+ High initiative and ability to efficiently and effectively lead interdisciplinary teams and coordinate and manage RAI process… more
- Alameda Health System (Oakland, CA)
- …a supervisory or lead role. **Required Licenses/Certifications:** Active licensure as a Registered Nurse in the State of California or licensed in Clinical ... and internal compliance studies. + Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals .… more
- Alameda Health System (Oakland, CA)
- …nursing background. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. Preferred ... listed are necessarily performed by each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training,… more
- HCA Healthcare (Greenwood Village, CO)
- …of Hospice and /or relevant end of life care experience preferred. + Licensed as a Registered Nurse in the state(s) in which he/she will be providing services. + ... appeals and denials as requested. + Provides a lead role regarding oversight and approval of effective workflow...of five (5) years of experience as a professional nurse with two (2) years administrative/supervisory experience preferred. +… 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 ... for Medicare and Medicaid Services (CMS), Iowa Department of Inspections and Appeals (IDIA), The Joint Commission (TJC),etc.), in conjunction with the hospital's… more