- Stanford Health Care (Palo Alto, CA)
- …+ CCDS - Cert Clinical Document Spec required within 180 Days + RN - Registered Nurse - State Licensure And/Or Compact State Licensure preferred . **Physical ... to support appeals . + Collaboration with Management: Identify and escalate denial patterns to the Manager of Government Audits and Appeals , providing… more
- McLaren Health Care (Grand Blanc, MI)
- …communication with related disciplines to address and integrate opportunities for denial appeals . **Essential Functions and Responsibilities as Assigned:** 1. ... Assists in ensuring day-to-day activities of the Denial Appeal department are conducted in an accurate and...tools, and methodologies. _Required:_ + State licensure as a Registered Nurse (RN) + Bachelor's degree in… more
- Molina Healthcare (Salt Lake City, UT)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals ... quality and cost-effective member care. Candidates with UM and Appeals experience are highly preferred Work hours: Monday- Friday...or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active… more
- BronxCare Health System (Bronx, NY)
- …response by the department physician advisors and clinical staff. Qualifications - NYS Registered Nurse required - The Appeal Manager must have excellent verbal ... in letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and...electronic database system. -The Appeal Manager should be a nurse who has 3-5 years or more of experience… more
- Montrose Memorial Hospital (Montrose, CO)
- …letter writing, eg, appeals , preferred. + Must at least be Licensed as a Registered Nurse in the State of Colorado or possess a Compact State License. + ... to the patient. About The Career: + The Clinical Denial Analyst is a key contributor within the interdisciplinary... Analyst is a key contributor within the interdisciplinary Denial Management Program and is responsible for completing, tracking,… more
- McLaren Health Care (Mount Pleasant, MI)
- …auditors . Provides support to both internal and external customers for denial / appeals activities and audits. Assists with monitoring and auditing activities, ... requests for medical record documentation and the filing of responses and appeals . 1. Appropriately documents denial /appeal activities; oversees and documents… more
- BronxCare Health System (Bronx, NY)
- …special projects and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate ... the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to… more
- CommonSpirit Health (Centennial, CO)
- …BSN required Minimum Experience required: 4 years clinical experience as a Registered Nurse . 3 years with progressive experience in utilization review, ... who care about your success. The RN Clinical Denials Appeals Specialist functions as a revenue management liaison for...preferred. Prior experience writing clinical denial appeal letters required. License Required: Curent RN License… more
- Cognizant (Annapolis, MD)
- …Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work ... related to clinical denial management and managing clinical denials from Providers to...to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined… more
- Beth Israel Lahey Health (Plymouth, MA)
- …+ Collaborates with the multidisciplinary team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR ... Manager and/or physician advisor regarding cases that do not meet established guidelines for admission or continued stay. + Acts as a liaison between physicians and payers, coordinating peer-to-peer phone calls. + Collects and compiles data as required. _It is… more
- Molina Healthcare (Buffalo, NY)
- …and/or coding experience, or equivalent combination of relevant education and experience. + Registered Nurse (RN). License must be active and unrestricted in ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Provides support for medical claim… more
- Childrens Hospital of The King's Daughters (Chesapeake, VA)
- …duties as assigned. + LICENSES AND/OR CERTIFICATIONS + Current Virginia state license as a Registered Nurse or Registered Nurse holding a valid Compact ... + GENERAL SUMMARY + The Revenue Integrity Nurse Auditor is responsible for the auditing and...supporting documentation, as well as facilitates the completion of appeals in a timely manner. + Prepares trend and… more
- Saint Francis Health System (OK)
- …levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the details of reimbursement ... Nursing. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License. Work Experience: Minimum 2 years of… more
- Houston Methodist (Sugar Land, TX)
- …and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure - Must ... is responsible for performing utilization review activities, and monitoring the clinical denial management and appeals process, as applicable, in collaboration… 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 in an ... lengths of stay, enhanced organizational efficiency, and maximized reimbursement through denial reduction and successful appeals . The *System Care Coordination… 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) or Master ... **Job Summary and Qualifications** The Inpatient Authorization Review Services Behavioral Health Registered Nurse or Licensed Mental Health Counselor (LMHC) or… 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 ... denied cases when necessary and assists physicians with appeals . Maintains minimal denial rates by Medicare, MediCal, private and contracted payers through… more
- Swedish Health Services (Seattle, WA)
- …Degree Nursing degree (BSN) from an accredited school of nursing. + Upon hire: Washington Registered Nurse License + 3 years Registered nursing experience in ... focus on what really matters - our patients.** The Utilization Review (UR) Nurse has a strong clinical background blended with a well-developed knowledge and skills… more
- Highmark Health (Monroeville, PA)
- …also building relationships across the organization in a community setting. **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care ... contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials/ appeals and retrospective payer audit denials. Collaboratively formulates plans… 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), or ... established by the managed care contracts. Investigates and prepares appeals for insurance companies, when denial of...and prepares appeals for insurance companies, when denial of reimbursement is related to medical necessity or… more
