- R1 RCM (Boise, ID)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Supervisor** , you will help support clinicians ... position. **Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor...for additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position,… more
- R1 RCM (Salt Lake City, UT)
- …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Nurse ** , you will help our ... position. **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct...at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position,… more
- CDPHP (Albany, NY)
- …share these 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 ... of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity...external review, and making recommendations for change. QUALIFICATIONS: + Registered Nurse , Physician Assistant or Nurse… more
- HCA Healthcare (Nashville, TN)
- …required + Relevant education may substitute experience requirement + Currently licensed as a registered nurse ( RN ) or in the state(s) of practice and/or ... over 156,000 hours volunteering in our communities. As a Clinical Appeals Team Lead with Parallon you...Unlock your potential! **Job Summary and Qualifications** The Compliance Nurse Team Lead is responsible for providing clinical… more
- R1 RCM (Chicago, IL)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you will help ... position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** +...external compliance deadlines are met. **Required Skills:** + Active Registered Nurse license + **Active AHIMA or… more
- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, September 9, 2024 Centers Plan for Healthy Living's ... both verbally and in writing. + Analyze and complete written summaries on clinical cases. EDUCATION AND EXPERIENCE: Education: RN required. Required: RN… more
- LA Care Health Plan (Los Angeles, CA)
- …an enthusiastic team player. Must be able to work independently. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and unrestricted ... Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US,… more
- VNS Health (Manhattan, NY)
- …Will Do + Responsible for direct oversight and the day to day management of clinical appeals review processes within Appeals & Grievances Department. + ... to day activities for staff handling of grievances and appeals for one of the following VNS Health Plans...+ License and current registration to practice as a registered professional nurse in New York State… more
- Carle (Urbana, IL)
- …Location: Carle at The Fields + Weekend Requirements: no + Other Posting Information: Registered Professional Nurse ( RN ) License Illinois upon hire. + ... clinical documentation review to establish and manage clinical and prior authorization denial appeals for...REQUIREMENTS Bachelor's Degree in Nursing CERTIFICATION & LICENSURE REQUIREMENTS Registered Professional Nurse ( RN ) License… more
- Magellan Health Services (Albuquerque, NM)
- …State Licensure - Care Mgmt, PT - Physical Therapist, State Licensure - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... care. Oversees utilization management and criteria-based reviews of care, clinical appeals regarding medical necessity, and the...policies and processes. Also oversees the health plans 24/7 Nurse Line program and the clinical management… more
- Stanford Health Care (Palo Alto, CA)
- …**This is an onsite Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN ) will be responsible for ensuring the ... Stay current with regulatory policies and guidelines related to clinical appeals . + Apply regulatory knowledge to...systems and other healthcare software. **Licenses and Certifications** + Nursing/ RN - Registered Nurse -… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …a systems and implementations team. FEP is BCBSMA's single largest account Position Summary: The RN Clinical Provider Post Service Review Manager , led by a ... a member and provider call center, provider correspondence and appeals , clinical review, member correspondence and reconsiderations,...Registered Nurse , is responsible for a team… 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 ... of all areas of adult medicine. (Required) Department / Location Specific Notes Additional Registered Nurse licensure may be required within one year of hire,… more
- Trinity Health (Springfield, MA)
- …program. BSN graduate preferred, Master's preferred + **Licensure** : Current Licensure as a Registered Nurse RN in Massachusetts. + **Certification** : BLS ... level of care determinations using screening criteria, and assists the physician, bedside Registered Nurse , ICC and Social Worker with utilization management and… more
- University of Michigan (Ann Arbor, MI)
- …of illness, expected risk of mortality, accuracy of patient outcomes, PSI90/HAC reviews, clinical denials and appeals and complexity of patient care. Serves as ... Clinical Documentation Integrity Specialist III Apply Now **Job...a RHIT or RHIA and or certification as an RN , or a bachelor?s degree and certification in Nursing… more
- CareFirst (Baltimore, MD)
- …Case Management, Utilization Management including prior authorization, and post service clinical medical review and Appeals & Grievances operational functions ... authorization meet all Federal, State and NCQA requirements. + Appeals , Grievances & Clinical Medical Review: Oversees...operating budgets, and large teams. **Preferred Qualifications:** + MBA, RN or MD/DO. + Previous experience at the Vice… 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
- Mount Sinai Health System (New York, NY)
- …nursing practice assigned in an acute care hospital setting. + Licensed as a registered nurse with current registration in New York State. Non-Bargaining Unit, ... in monthly Nursing Department meetings. + Works with unit case managers, clinical nurse managers, physicians, and social workers to facilitate Interdisciplinary… more
- Mount Sinai Health System (New York, NY)
- …5 years of case management experience and 5 -7 years of experience as a clinical nurse . Licensing and Certification Requirements (if applicable) License: RN ... in monthly Nursing Department meetings. 5. Works with unit case managers, clinical nurse managers, physicians, and social work to facilitate Interdisciplinary… more
- HCA Healthcare (El Paso, TX)
- …anticipated or verified denials and cooperates with denials management to provide additional clinical information for appeals . + You will educate patient and ... team is looking for a(an) Manager of Case Management RN . HCA Healthcare is an advanced healthcare network that...by location._** HCA Healthcare is committed to research and clinical protocols. Do you want to impact standards of… more