- 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 ... and executes the appeal process for all AHS facilities clinical appeals and third party audits. **DUTIES...or health plan. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California,… more
- Community Health Systems (Franklin, TN)
- …years of clinical nursing experience. + **Certificates and Licenses:** Current RN license to practice in state **Preferred** + Utilization review and/or case ... assigned. + File medical necessity and level of care appeals using InterQual and CMS guidelines as needed. +...using InterQual and CMS guidelines as needed. + Monitor clinical appeal processes for issues and trends and provide… more
- Northwell Health (Melville, NY)
- …stay. Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately ... 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… 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
- 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
- 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 ... an administrative clinical setting, including 1-2 years medicaid managed care appeals process & Health/Human Services. + The ability to effectively interact with… more
- City and County of San Francisco (San Francisco, CA)
- …( RN ) license issued by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a valid Clinical ... designing and implementing plans for meeting such needs. The Clinical Nurse Specialist (Critical Care)...related duties as assigned/required. + License and Certification: + Registered Nurse License: Possession of a valid… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve ... experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred.… 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 ... are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Clinical Training Specialist is responsible for the development,… 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
- 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 ... perspective. This person will be responsible for preparing appeals and communication with the clinical team...and Requirements 3+ years experience as a utilization review nurse Experience reviewing and analyzing denied claims Knowledge of… more
- City and County of San Francisco (San Francisco, CA)
- …of field or clinical experience as an Emergency Medical Technician-Paramedic (EMT-P), Registered Nurse , or Physician Assistant; OR four (4) years of field or ... Possession of a current, valid license or certificate as a Registered Nurse , Emergency Medical Technician-Paramedic (EMT-P), Emergency Medical Technician… more
- CaroMont Health (Gastonia, NC)
- …denial activity and appeal results. Maintains the Status Change Database. Performs retrospective clinical reviews/ appeals as part of denial process. The UR ... duties as assigned. Qualifications: Bachelor's degree from an accredited college with a clinical background. BSN required. Current RN license to practice in NC… 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
- 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
- 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 01/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 12/17/2024 Closing Date...years of full-time experience providing patient care as a Registered Nurse . W ork experience less than… more
- Centene Corporation (Tallahassee, FL)
- …Licensed Clinical Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), Registered Nurse ( RN ), or Licensed Psychologist (Ph.D. or Psy.D.) ... maintain the audit process and tools related to: authorizations, appeals , quality events, and case management in CCMS; interrater...auditing outcomes and system maintenance with the Sr. + Clinical Systems Specialist to resolve or enhance… more
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