- BayCare Health System (Clearwater, FL)
- …team member be working remotely?** Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Clinical Appeals Nurse - Health Plan **Location** ... review processes including how to analyze and research clinical issues and the appeals and grievance...of experience with case management and/or clinical appeals or claims. + Registered Nurse **Facility:**… more
- University of Washington (Seattle, WA)
- …**UW Medicine's Patient Financial Services Department** has an outstanding opportunity for a ** Clinical Appeals and Disputes Nurse .** **WORK SCHEDULE** + ... FTE + 100% Remote + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ...and communicated payer decisions in a timely manner + Review clinical denials and initiate appeals… more
- TEKsystems (San Bernardino, CA)
- Description We are seeking a dedicated Clinical Appeals Nurse to join our Revenue Cycle Management team. The ideal candidate will be responsible for managing ... just does follow up. Skills clinical data analysis, appeals , medical reimbursement, clinical review , collections medical Top Skills Details clinical… more
- TEKsystems (San Bernardino, CA)
- Clinical Appeals Nurse - Revenue...ability to interpret complex medical records. + Experience in clinical appeals , utilization review , or revenue ... Cycle Management We are looking for a Clinical Appeals Nurse to join...inpatient stays-ranging from 5 days to 100+ days-requiring detailed review and strategic appeal preparation. Key Responsibilities + … more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & Grievances ... Clinical ) is responsible for the daily oversight of clinical appeals and grievances functions within the...for accuracy, clarity, and cultural appropriateness and sensitivity. + Review and monitor procedures for identifying quality of care… more
- Elevance Health (Mason, OH)
- ** Nurse Appeals -Licensed Nurse **...Review requests. .Acts as a resource for both clinical and non- clinical teams, by managing and ... necessary and is dependent on court hearing schedules. The Nurse Appeals is responsible for investigating and...including ensuring accurate entry, investigation, and analysis of state appeals ; summarizing medical information for review by… more
- Elevance Health (FL)
- ** Nurse Appeals - Litigation & Legal Support** **In Office Expectation:** This role is **Virtual** ; This role enables associates to work virtually full-time, ... necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support**...including ensuring accurate entry, investigation, and analysis of state appeals ; summarizing medical information for review by… more
- Elevance Health (Columbus, OH)
- ** Nurse Appeals RN** **Location** : Ohio-Cincinnati, Columbus, Mason, or Seven Fields _(Must be within commutable distance to the listed locations.)_ ... an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and...medical information for medical director, consultants and other external review . + Prepares recommendations to either uphold or deny… more
- CVS Health (Baton Rouge, LA)
- …solutions. In particular responsible for the review and resolution of clinical documentation, clinical complaints and appeals . Reviews documentation and ... obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and...structure and regulatory requirements are required to support the appeals review . -Pro-actively and consistently applies the… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- BJC HealthCare (St. Louis, MO)
- …and VitalWare to review documentation to write a compelling appeal. The Clinical Appeals Specialist must be able to identify trends and escalate them ... Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist with infusion... clinical denials and sending them to a nurse to review and appeal and then… more
- BronxCare Health System (Bronx, NY)
- …arrive in letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal ... Overview The Appeals Manager is responsible to assist in the...for timely response by the department physician advisors and clinical staff. Qualifications - NYS Registered Nurse … more
- Nuvance Health (Danbury, CT)
- …REQUIRED* * *Hybrid/Remote* * *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within ... critical part in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with CMS requirements,… more
- LA Care Health Plan (Los Angeles, CA)
- …in Nursing for Registered Nurses Experience Required: At least 8 years of clinical appeals and grievances experience in a managed care, utilization management ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical... unit. This position is responsible for the quality review of complex and/or escalated clinical A&G… more
- Henry Ford Health System (Troy, MI)
- …Nurse ! We are a team of Registered Nurses (3 and counting) and Utilization Review Coordinators (4) that review appeals for medical necessity using ... RN PROVIDER APPEALS COORDINATOR - MEDICAL APPEALS -...+ Responsible for investigating Provider Appeal requests and Code Review inquiries for all Utilization Management divisions, including delegated… more
- Northwell Health (Melville, NY)
- …+ Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect ... decisions and billing status and ensures compliance with the Utilization Review standard and regulations. + Performs concurrent and retrospective utilization… more
- Dignity Health (Rancho Cordova, CA)
- …regulatory appeals , and maintaining a detailed activity log for leadership review . The nurse will actively participate in audits, identifying and ... and maintaining patient confidentiality (HIPAA) are also essential. Ultimately, the Appeals and Grievances Nurse monitors denial trends, recommends corrective… more
- Cognizant (Salem, OR)
- …, and retro-authorization as well as timely filing deadlines and processes. + Review clinical denials including but not limited to referral, preauthorization, ... cycle or clinic operations + Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews +… more
- UNC Health Care (Kinston, NC)
- …for all audit and appeals work activities. Assists with documentation review to support the clinical documentation specialists and Patient Financial ... + Minimum 3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review , care management, or compliance experience… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …may require up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the ... Nurse issued by the State of Minnesota. **Title:** *Staff Nurse - Utilization Review (ED)* **Location:** *MN-Minneapolis-Downtown Campus* **Requisition ID:**… more
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