- Trinity Health (Farmington Hills, MI)
- …**MINIMUM QUALIFICATIONS** Must possess a demonstrated knowledge of denial management functions. Registered Nurse and a graduate of an accredited school of ... causes of clinical denials. Responsible for leveraging clinical knowledge and standard procedures to track appeals...and reviews findings with all levels of Payment Resolution Specialist for further review. Serve as a resource to… 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
- McLaren Health Care (Bay City, MI)
- …institution + State of Michigan licensure as a Registered Nurse ( RN ) + Two years of recent clinical or utilization management experience **_Preferred:_** ... **_Position Summary_** **:** In conjunction with the admitting/attending physician, the UR Specialist RN assists in determining the appropriate admission status… 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
- American Red Cross (Toledo, OH)
- …NEED TO SUCCEED (Minimum Qualifications_** **):** + **Current state licensure as a Registered Nurse and CPR certification is required** **.** + **Bachelor's ... as a consultant to external health care personnel about clinical apheresis. + Assess patient status relative to therapeutic...make a difference by volunteering in a position that appeals to you and allows you to use your… more
- State of Colorado (Chaffee County, CO)
- CDOC Registered Nurse - Part-time - Buena Vista 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/4564337) Apply CDOC Registered Nurse - Part-time - Buena Vista...Colorado? If so, what state issued your license? 07 Nurse Licensure Compact: If appointed to an RN… more
- Cleveland Clinic (Weston, FL)
- …as assigned. **Education:** *Graduate of an accredited school of nursing with licensure as a Registered Nurse ( RN ) in the State of Florida. *Bachelor of ... the payer, UM data collection and reporting, concurrent denials appeals process, clinical team interaction, Physician Adviser...valid license in the State of Florida as a Registered Nurse ( RN ). *Basic Life… more
- 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
- 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...(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 ... **Employment Type:** Full time **Shift:** Day Shift **Description:** The purpose of the Clinical Integration Specialist is to assist and support the Director in… more
- BrightSpring Health Services (Louisville, KY)
- …be met. This position will also support detailed level reporting and analytics, clinical appeals , root cause analysis, and address identified trends in reasons ... Our Company BrightSpring Health Services Overview The Clinical Coding and Audit Specialist monitors,...timely, compliant documentation that drives accurate billing Qualifications + Clinical review positions will require a RN … more
- Fallon Health (Worcester, MA)
- …follow us on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** **The Program Specialist , Clinical ACO Team:** + Understands and is a subject matter ... the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge,… more
- Healthfirst (NY)
- …OR Dental Hygienist Preferred Qualifications: + Bachelors degree + Experience in clinical practice with experience in appeals & grievances, claims processing, ... and Responsibilities: + Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity,… more
- LifePoint Health (Brentwood, TN)
- …Certification in Clinical Documentation Improvement (CCDS or CDIP) *Certifications:* Nurse , medical school graduate, physician assistant ( RN , NP, PA, ... *DRG Downgrade Specialist * *Who we are:* At Lifepoint Health, we...as a navigator for the process flow and denial appeals of complex clinical coding cases. *Responsibilities:*… more
- American Red Cross (Philadelphia, PA)
- …a $7,000- Sign-On Bonus** **_WHAT YOU NEED TO SUCCEED (Minimum Qualifications):_** + ** Registered Nurse with current state licensure as required.** + **A minimum ... as a consultant to external health care personnel about clinical apheresis. + The American Red Cross will provide...make a difference by volunteering in a position that appeals to you and allows you to use your… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and approve medically… more
- Centene Corporation (Brooklyn, NY)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... a fresh perspective on workplace flexibility. This position requires RN licensure in NYS. It is a field based...+ Assist member with filing and resolving complaints and appeals + Direct care to participating network providers +… 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 ... Nurse III 2/2024 Department Department of Corrections Division Clinical and Correctional Services Opening Date 02/08/2024 Closing Date...years of full-time experience providing patient care as a Registered Nurse . W ork experience less than… more
- State of Colorado (Crowley County, CO)
- …statement. 04 Do you possess a valid, active license from the State of Colorado as a Registered Nurse or Nurse Practitioner? + Yes + No 05 Enter your ... This position provides operational and supervisory oversight of multi-disciplinary clinical services staff working at the Arkansas Valley Correctional...Colorado Registered Nurse or Nurse Practitioner… more
- Trinity Health (Darby, PA)
- …time **Shift:** Evening Shift **Description:** Under the general supervision of the RN Care Coordination Manager and Director of Care Coordination, the Emergency ... Also collaborates with Social Work to ensure appropriate primary care and specialist physician follow up. Collaborates with the ED healthcare team to determine… more
Related Job Searches:
Appeals,
Appeals Specialist,
Appeals Specialist RN,
Clinical,
Clinical Appeals Specialist,
RN,
RN Clinical,
RN Clinical Appeals,
RN Specialist,
Specialist