- Carle (Urbana, IL)
- Outpatient Denial/ Appeals Specialist - RN + Department: Revenue Cycle - CFH_10_19 + Entity: Champaign-Urbana Service Area + Job Category: Clerical/Admin + ... Fields + Weekend Requirements: no + Other Posting Information: Registered Professional Nurse ( RN ) License...to establish and manage clinical and prior authorization denial appeals for the Carle enterprise. Represents Carle in clinical… more
- CDPHP (Albany, NY)
- …values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and grievance ... Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations… more
- Area Agency On Aging 1-b (Southfield, MI)
- The Appeals and Compliance Specialist is responsible for providing comprehensive responses in compliance with contract, regulatory and accreditation requirements ... information and communicate disposition of case . + Triages case inquiries, appeals , and prepares case files/packets for appeal hearings. Attend State Fair Hearings… more
- Diversicare Healthcare Services & Diversicare Ther (Brentwood, TN)
- **Overview** **Smile, You've Found Us!** **Remote position, LPN or RN , experience with MDS required** Are you passionate about caregiving? Would you like to work ... an electronic tracking system for all ADRS, denials, and appeals . 2. Communicate and collaborate with centers to ensure...1. Current nursing license by state board of nursing ( RN or LPN) or related Healthcare field 2. Experience… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** Appeals and Grievances Representative supports the Operations Department and the Appeals and Grievances team in a number of ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
- McLaren Health Care (Bay City, MI)
- …of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and achieve optimal ... other related duties as required and directed. **Qualifications:** **_Required:_** + Registered Health Information Technician (RHIT), Licensed Practical Nurse … 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. ... and audit requests and coordinates attempts to overturn denials by drafting appeals , negotiating with payers, or following up with payer utilization review… more
- LifePoint Health (Brentwood, TN)
- …hospital leadership. This position also provides oversight to the DRG Downgrade Appeals Specialist team. *Responsibilities:* . Oversee the operations and human ... to maintain and improve KPIs. . Develop and execute appeals management strategies for the DRG downgrade team. ....Perform other duties as assigned. *What you'll need:* *Education: * Nurse ( RN , NP, or graduate of a… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print...RN license. 07 Do you possess an active RN license issued by an Enhanced Nurse Licensure ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4555045) Apply CDOC Registered Nurse ( Nurse I) Salary $7,442.00 Monthly Location Statewide,… more
- State of Colorado (Sterling, CO)
- CDOC Registered Nurse - Part-time - Sterling Print...Yes + No 06 Do you possess an active RN license issued by an Enhanced Nurse Licensure ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4667564) Apply CDOC Registered Nurse - Part-time - Sterling Salary...Colorado? If so, what state issued your license? 07 Nurse Licensure Compact: If appointed to an RN… more
- Fairview Health Services (St. Paul, MN)
- …M Health Fairview has an immediate opening for a Utilization Management Specialist RN . This position provides comprehensive assessment, planning, coordination, ... implementation, and reporting of complex clinical data. The Utilization Management Specialist is responsible for the completion of admissions and continued stay… more
- PeaceHealth (Vancouver, WA)
- …clinical DRG-downgrade denials in the inpatient acute care setting Credentials + Required: Registered Nurse In state of practice or + Required: Certified ... **Description** PeaceHealth is seeking a RN Clin Doc Integrity Specialist /Denial Reviewer...adult medicine. (Required) Department / Location Specific Notes Additional Registered Nurse licensure may be required within… more
- State of Nevada (NV)
- …or a hiring decision has been made. The Position Under direction, the Compliance Specialist - Registered Nurse provides medical expertise for the Division ... COMPLIANCE COORDINATOR - RN APPROXIMATE ANNUAL SALARY - $73,309.68 to $109,640.88...management; OR one year of experience as a Compliance Specialist - Registered Nurse in… more
- State of Indiana (Indianapolis, IN)
- Public Health Nurse Specialist Date Posted: Sep 25, 2024...minimally have either + a Bachelor's Degree with a Registered Nurse ( RN ) license, or + ... live, learn, work, or play. Role Overview: As a Nurse Specialist you will determine medical eligibility...an Associate's Degree with a Registered Nurse ( RN ) license plus… more
- Cleveland Clinic (Vero Beach, FL)
- …from an accredited school of professional nursing. + Current state licensure as a Registered Nurse ( RN ). + Basic Life Support (BLS) certification through ... to the payer, UM data collection and reporting, concurrent denials appeals process, clinical team interaction, Physician Adviser interaction and special projects… 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 ... Full time **Shift:** Day Shift **Description:** The purpose of the Clinical Integration Specialist is to assist and support the Director in quality and safety… more
- Tarrytown Rehabilitation & Nursing Center (Everett, MA)
- …the recruitment/interview process for MDS and MMQ vacancies. Qualifications: + Licensed as a Registered Nurse in the State of Massachusetts + Three to Five years ... CLINICAL REIMBURSEMENT SPECIALIST / MULTI FACILITY We offer competitive compensation and...(Medicaid, Medicare) and case management process (prior authorization and appeals ) required + Ability to multi-task and adapt to… more
- Hackensack Meridian Health (Neptune, NJ)
- …and serve as a leader of positive change. The **Care Coordination Specialist ** performs selected services and functions related Transitions of Care & Utilization ... Management, including insurance authorization, payer communications, Appeals and Denial information, and scheduling. This position is based out Jersey Shore… more
- University of Michigan (Ann Arbor, MI)
- Clinical Documentation Integrity Specialist III Apply Now **Job Summary** This Clinical Documentation Integrity Specialist III (CDIS III) position is fully ... accuracy of patient outcomes, PSI90/HAC reviews, clinical denials and appeals and complexity of patient care. Serves as key...a RHIT or RHIA and or certification as an RN , or a bachelor?s degree and certification in Nursing… more
- Hackensack Meridian Health (Hackensack, NJ)
- …serve as a leader of positive change. The Integrated Case Management Specialist performs selected services and functions related to insurance management with various ... ortho calls, payer communications and support of the Care Coordinators. Prepares required Appeals and Denial information for processing and follows up on receipt of… more