- Guidehouse (Huntsville, AL)
- …None **Clearance Required** **:** None **What You Will Do** **:** The **R** **emote** ** Clinical Denials RN** is responsible for review, analysis and appeal of ... **Job Family** **:** Clinical Appeals Nurse **Travel Required** **:**...clinical denials from insurance companies and third-party payers. This role… more
- CenterWell (Providence, RI)
- …or requested. **Use your skills to make an impact** **Required Experience/Skills:** + Registered Nurse or Physical Therapist. + Current state license as a ... caring community and help us put health first** The ** Denials Management Specialist** is responsible to respond to, monitor... Registered Nurse or Physical Therapist. + 5… more
- St. Mary's Healthcare (Amsterdam, NY)
- …of nursing required. Licensure / Certification / Registration: Required Credential(s): * Registered Nurse credentialed from the New York Board of Nursing. ... based on experience and other factors permitted by law. Responsibilities: * Uses clinical and coding knowledge to ensure accurate and compliant charge items and to… more
- Catholic Health Initiatives (Little Rock, AR)
- …State of Arkansas Bachelors Of Nursing Or related healthcare field Minimum three (3) years clinical experience as Registered Nurse (RN) 5 years of RN ... The RN has an integral role within the revenue cycle by providing clinical expertise in the denials management process. The Denials RN performs a root cause… more
- Veterans Affairs, Veterans Health Administration (Richmond, VA)
- …equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion ... condition on the Transfer Log, VISN 6 Bed Board, Daily Reports, etc. Entering clinical information in CPRS Charting and all administrative issues are to be charted… more
- Veterans Affairs, Veterans Health Administration (Smyrna, TN)
- …the integration of VHA and industry best standards. The Revenue Utilization review (RUR) Registered Nurse (RN) is an active member of the revenue cycle program ... established third-party payer criteria for reimbursement and appeal of clinical denials . Provides feedback as appropriate, for...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Children's Mercy Kansas City (Kansas City, MO)
- …per contracts for medically appropriate level of care. Manages concurrent clinical denials through completion of verbal reconsideration process. Works ... children beyond the walls of our hospital. Overview The Clinical Review Nurse Care Manager utilizes ...+ One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon… more
- Veterans Affairs, Veterans Health Administration (Middleton, WI)
- …Consolidated Patient Accounting Centers (CPAC) for revenue reimbursement. The RUR nurse applies advanced clinical knowledge, communication skills, and ... patient care through systematic evaluation and analytical review of clinical information. Responsibilities Responsibilities of the RUR nurse...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Texas A&M University System (College Station, TX)
- Job Title Registered Nurse II - Prior Authorization & Referral Agency Texas A&M University Health Science Center Department University Health Services Proposed ... and team-based health care delivery. What we want The Registered Nurse II-Prior Authorization and Referral, under...are denied. + Collaborate with providers to gather necessary clinical documentation and address denials or escalations.… 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 ... Managers in the department, including Utilization Management, Discharge Planning and Denials and Appeals functions. + Assessing workflow related to readmission… more
- Intermountain Health (Murray, UT)
- **Job Description:** The Nurse Case Manager utilizes clinical expertise and critical thinking skills to develop and implement a plan of care that provides cost ... denial prevention. Proactively intervenes with payers to prevent inpatient denials . Performs retroactive reviews on discharged patients as assigned....nurse practices. - and - Three years of clinical nursing experience. - and - RNs hired or… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a **Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, Barksdale ... One year of experience in Utilization Management is required. Full time employment as a registered nurse within the last 36 months is mandatory. Six years of … more
- AdventHealth (La Grange, IL)
- …AND EXPERIENCE REQUIRED:** . Associates Degree Nursing or RN Diploma degree . Registered Nurse (RN) . Two (2) years of medical/hospital nursing experience ... **LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:** . State of Illinois registered nurse license **LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:**… more
- Bon Secours Mercy Health (Warren, OH)
- …* Be mindful of revenue cycle components including scheduling, registration, clinical coverage/treatment, documentation, billing, collections, and denials . * ... effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Summary of Primary Function/General Purpose of… more
- R1 RCM (Boise, ID)
- …appeals.Represent clients at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay ... analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help...clients by serving as an expert on appeals and denials management where claims were denied by either governmental… more
- AdventHealth (Hinsdale, IL)
- …Discharge Planning + Conflict management and resolution skills + Teamwork principles + Registered Nurse (RN) Required + Certified Case Manager (CCM) Preferred + ... Manager ensures efficient and cost-effective care through appropriate resources monitoring, and clinical care escalations. The RN Care Manager is under the general… more
- AdventHealth (Maitland, FL)
- …+ Associate of Science degree in Nursing (ASN) + Current valid license as a Registered Nurse in the state of Florida + Two (2) years of medical/hospital ... Manager ensures efficient and cost-effective care through appropriate resources monitoring, and clinical care escalations. The RN Care Manager is under the general… more
- Beth Israel Lahey Health (Plymouth, MA)
- … clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient. ... or advanced degree in healthcare preferred. + Three years recent, broad clinical experience in the hospital setting + Experience with utilization management within… more
- AdventHealth (Winter Garden, FL)
- …Degrees without out-of-pocket tuition expense) *For eligible positions* + Nursing Clinical Ladder Program*For eligible positions* + Whole Person Well-being and ... Manager ensures efficient and cost-effective care through appropriate resources monitoring, and clinical care escalations. The RN Care Manager is under the general… more
- Children's Mercy Kansas City (Kansas City, MO)
- …skills in a previous role + One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire + One of the following: ... risk administrative processes and data related to medical necessity denials , clinical appeals, long length of stay...Licensed RN - Kansas, Registered Nurse Multistate License Kansas required upon… more