- CareFirst (Baltimore, MD)
- …informative, educational and training presentations for internal and external stakeholders. Supports the Manager of Clinical Appeals and Analysis in the ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates...Demonstrated leadership skills. In Lieu of Education. **Licenses/Certifications:** + RN - Registered Nurse -… more
- Hartford HealthCare (Wethersfield, CT)
- …identified patterns 9. Other duties as assigned. *_Reports To:_* Manager , Clinical Resource Management *_Education:_* Registered Nurse . Bachelors of ... rapidly changing medical environment. *_Position Summary:_* The Denial and Appeals Nurse is an integral part of...**Job:** **Other* **Organization:** **Hartford HealthCare Corp.* **Title:** *Denial and Appeals RN / Clinical Resource… 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: ...Care's culturally diverse membership. The position supports the A&G Clinical Manager . This role also assists the… more
- Select Medical (Los Angeles, CA)
- …Health and Select Medical Century City / Los Angeles, CA Case Manager (CM) - Registered Nurse ( RN ) or Social Worker (LCSW) - Per Diem **Pay Rate $66.00** ... protected under applicable law_ _._ Apply for this job (https://jobs-selectmedicalcorp.icims.com/jobs/320081/case- manager -%28cm%29 registered - nurse -%28rn%29-or-lcsw per-diem/job?mode=apply&apply=yes&in\_iframe=1&hashed=1374627814) Share this… more
- Molina Healthcare (Columbus, OH)
- … decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical ... every 4 weeks Monday-Thursday and Wed - Saturday._** **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct … more
- VNS Health (Manhattan, NY)
- …navigating the complexities of healthcare? VNS Health Plans is seeking a dedicated Manager , Grievance and Appeals ( RN )to lead the daily operations ... direct oversight and the day to day management of clinical appeals review processes within Appeals...+ License and current registration to practice as a registered professional nurse in New York State… 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
- CareFirst (Baltimore, MD)
- …**PURPOSE:** This position will support the government programs line of business. The Clinical Appeals Nurse completes research, basic analysis, and ... provider disputes regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes ...those with substance disorders and addictions. **Licenses/Certifications** : + RN - Registered Nurse -… more
- State of Colorado (Denver, CO)
- Registered Nurse I-$14,000 SIGN ON BONUS...during own shift and proximal shifts + Collaboration with Nurse Manager and treatment team, recommends a ... Health Hospital in Fort Logan-Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4845698) Apply Registered Nurse I-$14,000 SIGN ON BONUS Colorado… more
- Catholic Health Services (Melville, NY)
- …was named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... appeals according to industry accepted clinical criteria guidelines. The UAM serves as interdepartmental liaison...accredited Nursing School or College; current New York State, RN License required, BSN Bachelor of Science in Nursing… more
- Mount Sinai Health System (New York, NY)
- …education to Case Managers and other hospital personnel as needed. The Nursing Clinical Manager collaborates with Appeals Management, Managed Care ... **Job Description** The Nursing Clinical Manager (NCM) for Case Management...nurse . Licensing and Certification Requirements (if applicable) License: RN (current) and Certification Issuing Agency: NYS/ Department of… more
- Sharp HealthCare (San Diego, CA)
- … (CCM) - Commission for Case Manager Certification; Bachelor's Degree in Nursing; California Registered Nurse ( RN ) - CA Board of Registered Nursing; ... or equivalent experience in the healthcare setting. + California Registered Nurse ( RN ) - CA...will participate in venues to reduce barriers to discharge.The RN CM I Collaborates with Clinical Resource… more
- Select Medical (Los Angeles, CA)
- …CA Case Manager (CM) - Full Time (on-site) - 8 hr shifts Registered Nurse ( RN ) or Licensed Clinical Social Worker (LCSW) **Schedule: Sun - Thu or Tue ... to the patient. **Qualifications** **Minimum Qualifications** + Current licensure in a clinical discipline per state guidelines ( RN , LCSW preferred). + Previous… more
- Highmark Health (Wexford, PA)
- **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care and manages ... and contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials/ appeals and retrospective payer audit denials.… more
- State of Colorado (Denver, CO)
- …Health Facilities and Emergency Medical Services Division and Current, valid licensure as a Registered Nurse from the Colorado Board of Nursing or any state ... RN Health Compliance Inspector, Home Care Services HFEMS...years of experience and Current, valid licensure as a Registered Nurse from the Colorado Board of… more
- Whidbey General Hospital (Coupeville, WA)
- JOB SUMMARY The RN - Care Manager is a... will lead an assessment to identify the patient's clinical needs to be accommodated and constructs a care ... RN - Care Manager...acts as a resource to the interdisciplinary team providing clinical expertise in the areas of utilization review, status determination,… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …appeals and acquire authorizations for treatment Key Qualifications: + Current NYS Registered Nurse License/Registration and BSN preferred + At least 2-3 ... scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our...mission at MSK and around the globe. Job Description RN Case Manager , Inpatient | New York,… more
- University of Michigan (Ann Arbor, MI)
- RN CASE MANAGER : University Hospital (Care Management) Apply Now **Job Summary** The RN Case Manager assesses, develops, implements, coordinates and ... effective utilization of resources while promoting quality outcomes. **Organizational Relationships** The RN Case Manager reports directly to the Manager … more
- Mount Sinai Health System (New York, NY)
- …for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission). ... **Job Description** ** RN /Case Manager MSH Case Management FT...with physicians and managed care companies on concurrent denial appeals + Communicates clinical information to the… more
- UNC Health Care (Chapel Hill, NC)
- …of employment date. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North Carolina. **Professional ... through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff… more