- CDPHP (Albany, NY)
- …share these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal ... of clinical nursing and medical practices, the Clinical Appeals Specialist will review...external review, and making recommendations for change. QUALIFICATIONS: + Registered Nurse , Physician Assistant or Nurse… more
- 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
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... Appeals and Grievances (A&G) Nurse Specialist Registered Nurse ( RN...appropriate area within the department. Investigation, and resolution of clinical member complaints (grievances/ appeals ) utilizing all regulatory… 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
- 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
- State of Colorado (Denver, CO)
- CDOC Registered Nurse - Part-time - Denver 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/4737141) Apply CDOC Registered Nurse - Part-time - Denver Salary...Colorado? If so, what state issued your license? 07 Nurse Licensure Compact: If appointed to an RN… more
- Commonwealth Care Alliance (Boston, MA)
- CCA- Appeals & Grievances Processing of Grievances & Appeals : * Responsible for the progress of grievance and appeal intervention and resolution. * Assure verbal ... strict deadlines. * When necessary collaborate with care teams, clinical staff, family members, and other involved in providing...with CCA departments to help manage and resolve member appeals and grievances. * Act as a liaison between… more
- MetroHealth (Cleveland, OH)
- …socioeconomic backgrounds Preferred: Currently licensed or licensed by endorsement as a LPN, Registered Nurse , MD or MD equivalent. Minimum 5 years acute ... improve documentation accuracy. Reviews DRG downgrades and strategic CDI appeals , and responds to payor audits and inpatient downgrade...to experience noted below. Minimum of 5 years as Clinical Documentation Integrity Specialist or; - CDIP… more
- AdventHealth (Altamonte Springs, FL)
- …utilizing InterQual and/or MCG . Minimum of three (3) years' experience as Registered Nurse ( RN ) in an acute clinical setting . Clinical experience ... bring about the best opportunity for fair reimbursement. The Clinical Denial Management Specialist will adhere to...obtain further patient information to be used in the appeals process if necessary. . Provide reports, education, and… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks ... preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending....an accredited, professional nursing program. + Must have current RN license to practice in the state of Pennsylvania… 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
- 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
- Cleveland Clinic (Vero Beach, FL)
- …from an accredited school of professional nursing. + Current state licensure as a Registered Nurse ( RN ). + Basic Life Support (BLS) certification through ... information to the payer, UM data collection and reporting, concurrent denials appeals process, clinical team interaction, Physician Adviser interaction and… 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 (North Bergen, 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. **Responsibilities** A day in the life of a… 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
- Centene Corporation (Bronx, 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, ... Sign on Bonus for this position 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 (Denver, CO)
- …their job duties. This position works under the supervision and direction of a registered nurse and assists with psychiatric nursing care of mentally ill ... Provider of Therapeutic Patient Care: + Under the direction and supervision of a registered nurse , engage with patients to establish and maintain a therapeutic… more
- State of Colorado (Pueblo, CO)
- …Report changes in patient skin condition and patient health care complaints to shift registered nurse ; + Empty catheter bags; offer fluids and record Intake and ... but not limited to, the following: + In a clinical setting, assist patients with activities of daily living...pulse oximetry under the supervision and direction of a registered nurse ; + Maintain appropriate tool and… more
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