- VNS Health (Manhattan, NY)
- VNS Health is seeking a Registered Nurse ( RN ) Clinic Utilization Review for a nursing job in Manhattan, New York.Job Description & RequirementsSpecialty: ... as necessary, to investigate and facilitate resolution of individual grievances and appeals . Consults with enrollees, providers and the Medical Director, as… more
- Compass Health Network (St. Charles, MO)
- …preferredKnowledge of Microsoft Office Suite preferred LICENSURE/CERTIFICATION If Licensed Practical Nurse , license issued in Missouri required. LPN, RN or ... a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff...and regions, time traveled will be coordinated by SupervisorWill review medication education forms with client and review… more
- Compass Health Network (St. Charles, MO)
- …interest you, if running a Medication Clinic and acting as a case manager appeals to you! Our Compass Health Network Nursing Staff use the Compass "Champion" ... in other clinics and regions, time traveled will be coordinated by Supervisor Will review medication education forms with client and review clients need for… more
- Blanchard Valley Health System (Findlay, OH)
- …and procedures for service area. REQUIRED QUALIFICATIONS Current Ohio Licensure as a Registered Nurse Nursing experience 5+ years, 2-4 years in Care Coordination ... Team, including the disciplines of Social Work, Case Management, Utilization Review , and Emergency Department Care Navigation to support evolving and continuing… more
- Carle (Urbana, IL)
- …Location: Carle at The Fields + Weekend Requirements: no + Other Posting Information: Registered Professional Nurse ( RN ) License Illinois upon hire. + ... EDUCATIONAL REQUIREMENTS Bachelor's Degree in Nursing CERTIFICATION & LICENSURE REQUIREMENTS Registered Professional Nurse ( RN ) License Illinois upon… more
- CareFirst (Baltimore, MD)
- …work experience is required in addition to the required work experience. **Licenses/Certifications:** RN - Registered Nurse - State Licensure And/or Compact ... with dynamic goals resulting in the full and fair review of appeals and designed to achieve...and utilization management, and systems software used in processing appeals . + Knowledge and understanding of medical … more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …most appropriate decision within regulatory timeframes.The TeamAs an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer will serve ... and Medical Policy teams. Key Responsibilities: + Review provider and member appeals utilizing sound...with medical necessity determinations. Key Qualifications: + Registered Nurse or Licensed Practical Nurse… more
- R1 RCM (Chicago, IL)
- …orchestration. As our **Clinical Coding Appeals Nurse ** , you will help review and interpret medical records to draft appeals of denied and underpaid ... experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical...external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + **Active AHIMA or… more
- CDPHP (Albany, NY)
- …Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations ... will be responsible for tracking, trending and monitoring of appeals , grievances, NYS external review , and making...review , and making recommendations for change. QUALIFICATIONS: + Registered Nurse , Physician Assistant or Nurse… more
- CVS Health (Hartford, CT)
- …8a-5p in time zone of residence. **Position Summary** Responsible for the review and resolution of clinical appeals . Reviews documentation and interprets ... + Appeals Experience + Managed Care Experience + Utilization review experience + Proficiency with computer skills including navigating multiple systems +… more
- City and County of San Francisco (San Francisco, CA)
- …may result in dismissal and/or termination of employment. * California Registered Nurse ( RN ) Licenses (http://www. rn .ca.gov/) ... Possession of a valid permanent/temporary (including interim permit) California Registered Nurse License issued by the California...under Civil Service Rule 111A.35.1. The standard for the review of such appeals is 'abuse of… 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
- Stanford Health Care (Palo Alto, CA)
- …status and continued stay review , retrospective review of care, medical claims review , addressing denials/ appeals and grievances effectively and ... the utilization management, concurrent review , prior authorizations medical claims review , appeals and...in nursing (MSN) + Current unrestricted license as a Registered Nurse issued by the state of… more
- Molina Healthcare (Bronx, NY)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... eligible for Medicaid .** **We are looking for a RN Care Review Clinician with Prior Authorization...and MLTC/LTC experience are highly preferred. Additional experience with appeals , quality review , and experience with data… more
- Ascension Health (Manhattan, KS)
- …rules and regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Kansas Board of Nursing ... cases. + Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals . +… more
- Banner Health (AZ)
- …activities MINIMUM QUALIFICATIONS Completion of an Associate's degree in Nursing. Requires current Registered Nurse ( RN ) license in state worked. Five years ... experience and skills to BPN. As the Manager of RN Medical Management Services for Banner Plans...CORE FUNCTIONS 1. Leads and manages prior authorization, concurrent review , and case management staff within Medical … more
- LA Care Health Plan (Los Angeles, CA)
- …The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse ( RN ) II provides direct assistance to member's with ... Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category:...agencies. Good working knowledge of regulatory requirements/standards. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
- University of Virginia (Charlottesville, VA)
- …2 years acute care hospital experience. Licensure: Licensed to Practice as a Registered Nurse in the Commonwealth of Virginia required. PREFERRED QUALIFICATIONS: ... to promote and adhere to regulatory compliance. The UM RN conducts initial concurrent and retrospective medical ...to determine if denied cases will be appealed utilizing medical contract and payroll rules + Conducts appeals… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4555045) Apply CDOC Registered Nurse ( Nurse ... + Benefits + Questions Department Information *Waiver is in place for the Registered Nurse license requirement: Employment is contingent upon valid licensure as… more
- State of Colorado (Chaffee County, CO)
- CDOC Registered Nurse - Part-time - Buena Vista Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4626702) Apply CDOC Registered ... and staff instruction; + Assists physicians, physician assistants, and nurse practitioners with minor medical and surgical...Applicant must possess a current, valid license as a Registered Nurse from the Colorado Board of… more
