- 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
- 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
- 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
- Northwell Health (Melville, NY)
- …five (5) years of job entry date. + Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as ... current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect patient's severity of illness… more
- Community Health Systems (Franklin, TN)
- …Other duties may be assigned. + File medical necessity and level of care appeals using InterQual and CMS guidelines as needed. + Monitor clinical appeal processes ... persons. + Maintain documentation regarding all payor resources regarding denials and appeals processes. + Understand and apply CHS 10-Step Appeal Process for denied… more
- Healthfirst (NY)
- …Termination, and Suspension of services. The end to end process requires the Specialist to independently: + Research issues + Quality of Care Experience + Reference ... + Work within a framework that measures productivity and quality for each Specialist against expectations + Prepare cases for Medical Director Review ensuring that… more
- MaineGeneral Health (Waterville, ME)
- …to our patients and their families. MaineGeneral Hospice is currently seeking an experienced Registered Nurse ( RN ) for a 32-40 hour per week position. ... The Hospice Quality Specialist ensures that patient care services are delivered in...candidate will have: + A current license as a Registered Nurse in Maine or licensed from… more
- St. Luke's University Health Network (Allentown, PA)
- …near vision, visual monotony. EDUCATION: Graduate of an accredited professional nursing program. Registered nurse with current license to practice in the state ... ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for...preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending.… 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/4762850) 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/4756062) 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
- City and County of San Francisco (San Francisco, CA)
- …and Certification: + Registered Nurse License: Possession of a valid California Registered Nurse ( RN ) license issued by the California Board of ... Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a valid...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- City and County of San Francisco (San Francisco, CA)
- …years of field or clinical experience as an Emergency Medical Technician-Paramedic (EMT-P), Registered Nurse , or Physician Assistant; OR four (4) years of field ... Possession of a current, valid license or certificate as a Registered Nurse , Emergency Medical Technician-Paramedic (EMT-P), Emergency Medical Technician… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. ... Working in a fast-paced, high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and … more
- Point32Health (MA)
- …- what you need to perform the job** **EDUCATION, CERTIFICATION AND LICENSURE:** + Registered Nurse with a valid license required + Bachelor of Science in ... click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Clinical Training Specialist is responsible for the development, implementation, and execution of… 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 (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
- 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
- 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
- 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
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