- 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
- Alameda Health System (San Leandro, CA)
- Care Management Clinical Appeals Specialist + San Leandro, CA + Finance + Patient Financial Svcs - Facil + Full Time - Day + Business Professional & IT + Req ... executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES & ESSENTIAL JOB...or health plan. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California,… more
- 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
- 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 (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
- Commonwealth Care Alliance (Boston, MA)
- CCA- Appeals & Grievances Processing of Grievances & Appeals : * Responsible for the progress of grievance and appeal intervention and resolution. * Assure verbal ... with CCA departments to help manage and resolve member appeals and grievances. * Act as a liaison between...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… 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 (Denver, CO)
- CDOC Registered Nurse - Part-time - Denver 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/4737141) Apply CDOC Registered Nurse - Part-time - Denver Salary...Colorado? If so, what state issued your license? 07 Nurse Licensure Compact: If appointed to an RN… more
- MetroHealth (Cleveland, OH)
- …socioeconomic backgrounds Preferred: Currently licensed or licensed by endorsement as a LPN, Registered Nurse , MD or MD equivalent. Minimum 5 years acute ... opportunities to improve documentation accuracy. Reviews DRG downgrades and strategic CDI appeals , and responds to payor audits and inpatient downgrade requests when… more
- AdventHealth (Altamonte Springs, FL)
- …2 years utilizing InterQual and/or MCG . Minimum of three (3) years' experience as Registered Nurse ( RN ) in an acute clinical setting . Clinical experience ... best opportunity for fair reimbursement. The Clinical Denial Management Specialist will adhere to the AHS Compliance Plan and...obtain further patient information to be used in the appeals process if necessary. . Provide reports, education, and… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks ... preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending....an accredited, professional nursing program. + Must have current RN license to practice in the state of Pennsylvania… 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
- 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
- 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
- Hackensack Meridian Health (North Bergen, 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. **Responsibilities** A day in the life of a… more
- State of Colorado (Pueblo, CO)
- Employment First Specialist - Pueblo Regional Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4739131) Apply Employment First ... Specialist - Pueblo Regional Center Salary $21.68 - $30.36...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- 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
- 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
- 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
- Centene Corporation (Bronx, 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
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