• Outpatient Denial/ Appeals

    Carle (Urbana, IL)
    Outpatient Denial/ Appeals Specialist - RN + Department: Revenue Cycle - CFH_10_19 + Entity: Champaign-Urbana Service Area + Job Category: Clerical/Admin + ... Home + 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
    Carle (08/23/24)
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  • Clinical Appeals Specialist

    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
    CDPHP (10/26/24)
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  • Specialist , Grievance and Appeals

    VNS Health (Manhattan, NY)
    …pertaining to State Fair Hearings. Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in defense of the ... OverviewResolves grievances, appeals and external reviews for VNS Health Plans...decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and… more
    VNS Health (10/25/24)
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  • Customer Solution Center Appeals

    LA Care Health Plan (Los Angeles, CA)
    Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist ...under the direct supervision and management of the A&G Nurse Specialist , RN and/or Medical… more
    LA Care Health Plan (11/04/24)
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  • Customer Solution Center Appeals

    LA Care Health Plan (Los Angeles, CA)
    …Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse ( RN ) II provides direct assistance to ... Customer Solution Center Appeals and Grievances Nurse Specialist RN II...agencies. Good working knowledge of regulatory requirements/standards. Licenses/Certifications Required Registered Nurse ( RN ) - Active,… more
    LA Care Health Plan (10/11/24)
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  • Appeals Specialist

    Intermountain Health (West Valley City, UT)
    …Physician Advisor and works with them for obtaining support for appeals . + Collaborates with Care Management, Physician Advisors, Revenue Integrity, Compliance, ... legal counsel, and RSC teams to prepare appeals . + Identifies trends and opportunities for denial prevention...mentor to others within the RCO, clinical departments, Appeal RN 's, legal, IPAS and Payor Contracting on Minimum Qualifications… more
    Intermountain Health (10/29/24)
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  • Appeals & Grievance Specialist

    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
    Commonwealth Care Alliance (09/07/24)
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  • Appeals Audit Specialist - McLaren…

    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
    McLaren Health Care (09/26/24)
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  • Clinical Documentation Integrity (CDI) Manager…

    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
    LifePoint Health (09/14/24)
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  • CDOC Registered Nurse ( Nurse

    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 (09/26/24)
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  • Utilization Management Specialist RN

    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
    Fairview Health Services (09/25/24)
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  • RN -Denial Reviewer- remote

    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
    PeaceHealth (10/01/24)
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  • Utilization Management Specialist NE

    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
    Cleveland Clinic (10/31/24)
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  • Clinical Reimbursement Specialist / Multi…

    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
    Tarrytown Rehabilitation & Nursing Center (10/31/24)
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  • Care Coordination Specialist

    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
    Hackensack Meridian Health (10/24/24)
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  • Utilization Review Specialist

    CaroMont Health (Gastonia, NC)
    …retrospective clinical reviews/ appeals as part of denial process. The UR Specialist will be cross trained to work for the Commercial Resource Analyst when ... attending physicians regarding utilization issues. Collaborates with discharge planning specialist and other disciplines. Retrospectively reviews discharged medical record… more
    CaroMont Health (10/26/24)
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  • Clinical Denials Specialist

    Insight Global (Skokie, IL)
    Job Description Insight Global is looking for a clinical denials specialist to join the team at one of your healthcare clients in Chicago. As a Clinical Denials ... Specialist you will be working with the denials team...clinical perspective. This person will be responsible for preparing appeals and communication with the clinical team members. With… more
    Insight Global (10/04/24)
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  • CDOC Nurse Supervisor

    State of Colorado (CO)
    …Rights MINIMUM QUALIFICATIONS: + Applicant must possess a current, valid license as a Registered Nurse from the Colorado Board of Nursing or any state ... years of full-time experience providing patient care as a Registered Nurse . W ork experience less than...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
    State of Colorado (10/03/24)
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  • Long Term Care Nurse Specialist

    Centene Corporation (Brooklyn, NY)
    …Fidelis is offering a $10K Sign on Bonus for this position This position requires RN licensure in NYS. It is a field based position visiting member in their homes ... term care services + Assist member with filing and resolving complaints and appeals + Direct care to participating network providers + Participate in care management… more
    Centene Corporation (09/15/24)
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