- Molina Healthcare (Salt Lake City, UT)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse ( RN ) provides support for internal appeals clinical processes - ensuring that ... to provide quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- MVP Health Care (Tarrytown, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare** to join #TeamMVP. If you have a ... passion for patient-centered advocacy, clinical precision and regulatory compliance this is an opportunity...UM platforms. + Familiarity with CMS regulations and appeals processes. + Ability to work independently and manage… more
- Centene Corporation (Salem, OR)
- …analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters ... for member and provider clinical appeals and ensure letters are compliant...assigned + Complies with all policies and standards **Education/Experience:** RN with 4+ years of clinical nursing… more
- Trinity Health (Langhorne, PA)
- …experienced Registered Nurse to join our team in Utilization Review! The UM Registered Nurse is responsible for the coordinating and facilitating all ... aspects of reimbursement as related to the clinical review and level of care. Management of all...and level of care. Management of all review and appeals utilizing a modified approach based on specific needs… more
- US Tech Solutions (Columbia, SC)
- …if progressing well, can be moved to work remote. + Prefer 2 yrs. UM and/or appeals experience. + Experience with prior insurance, utilization management, case ... temp to hire)** **Job Description:** + Must be an RN in SC and have an active and unrestricted...appeals by both member and provider based on clinical documentation, contractual requirements, governing agencies, policies and procedures,… more
- CVS Health (Atlanta, GA)
- …with heart, each and every day. **Position Summary** CVS Aetna is seeking a dedicated ** Appeals Nurse Consultant** to join our remote team. In this role, you ... critical role in ensuring fair and accurate resolution of clinical appeals by applying sound clinical...UM (includes expedited), MPO, Coding, or Behavioral Health appeals . + This is a full-time telework position with… more
- HCA Healthcare (Gainesville, FL)
- …that invests in you as a Inpatient Authorization Review Services Behavioral Health Registered Nurse ( RN ) or Licensed Mental Health Counselor (LMHC) ... the account being denied by the payor that require clinical expertise. Communicates with third party payors to resolve...care contracting, experienced preferred. + Currently licensed as a registered nurse ( RN ) in the… more
- Swedish Health Services (Seattle, WA)
- …Upon hire: Washington Registered Nurse License + 3 years Registered nursing experience in the clinical setting. **Preferred Qualifications:** + Upon ... **Description** **Utilization Review RN @ Swedish Medical Center** **Part time 0.7...really matters - our patients.** The Utilization Review (UR) Nurse has a strong clinical background blended… more
- Saint Francis Health System (OK)
- …in various levels of care and receipt of necessary services. The Utilization Management ( UM ) Registered Nurse will communicate with providers the details of ... Nursing. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum 2 years of… more
- Molina Healthcare (OH)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (NM)
- …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying that services are… more
- Corewell Health (Royal Oak, MI)
- …experience in care management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan License Upon ... criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization… more
- Corewell Health (Grand Rapids, MI)
- … clinical nursing and or case management/managed care or related field Preferred + Registered Nurse ( RN ) - State of Michigan Upon Hire required + ... waiting list, insurance prior authorizations, continuous stay reviews and appeals . Additional support to the UM functions...within 7 years for those who start in this RN role on or after January 1, 2017 (Spectrum… more
- Whidbey General Hospital (Coupeville, WA)
- JOB SUMMARY Are you a flexible, self-motivated RN who thrives in a collaborative, fast-paced environment? At WhidbeyHealth, our Care Managers play a vital role in ... at the right time-we'd love to meet you! The RN - Care Manager is a health care professional...Manager will lead an assessment to identify the patient's clinical needs to be accommodated and constructs a care… more
- University of Michigan (Ann Arbor, MI)
- RN CASE MANAGER: University Hospital (Care Management) Apply Now **Job Summary** The RN Case Manager assesses, develops, implements, coordinates and monitors a ... care areas. The position is unique in that it combines clinical /quality considerations with regulatory/financial/utilization review demands. The position creates a… more
- UnityPoint Health (Cedar Rapids, IA)
- …care, optimal clinical outcomes and patient and provider satisfaction. The UM Specialist provides the Utilization Management function for patients admitted to BH ... with physicians, third party payers and regulatory agencies. The UM spcialist will also be called upon to provide... spcialist will also be called upon to provide clinical and nursing expertise and support within the HOD… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …license; must maintain licensure throughout employment + Minimum of 5 years' experience in Clinical Appeals and Grievances within a managed care or payor setting ... regulatory guidelines including URAC, NCQA, and ERISA + Proficiency in Clinical Appeals , Utilization Review, and Grievance processes including benefit… more
- Cedars-Sinai (Beverly Hills, CA)
- …that fuels innovation. **A Little More About What You Will be Doing** The RN Care Coordinator is responsible for the case management of patient while hospitalized ... care settings. In collaboration with the Inpatient Specialty Program (ISP) hospitalists, the RN Care Coordinator will assist patients from the time they are admitted… more
- Nuvance Health (Danbury, CT)
- …or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience in an acute care setting * ... for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while partnering...ensure CMS and regulatory compliance.* *Develop and maintain a UM plan to guide the team with detailed processes… more
- Saint Francis Health System (Tulsa, OK)
- …field. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License, or Clinical Social Worker (LCSW), ... through Friday, 8:00 am to 5:00 pm** Job Summary: Provides administrative and clinical support to the hospital and treatment team throughout the review of patients,… more