- Trinity Health (Farmington Hills, MI)
- …root causes of clinical denials . Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, second, ... Position (Pay Range: $34.9314-$52.3971) Responsible for reviewing all post-billed denials (inclusive of clinical denials )...Must possess a demonstrated knowledge of denial management functions. Registered Nurse and a graduate of an… more
- Highmark Health (Harrisburg, PA)
- …and contractual requirements. (30%) + Documents, monitors, intervenes/resolves, and reports clinical denials / appeals and retrospective payer audit ... functioning as a liaison with third party payers, communicating clinical information to the insurance companies as requested, addressing and… more
- Highmark Health (Harrisburg, PA)
- …all regulatory and contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials / appeals and retrospective payer audit ... **Preferred** + None **EXPERIENCE** **Required** + 2 years of recent clinical RN Acute care, Home care, Palliative, Hospice, or Care Management **Preferred**… more
- Trinity Health (Darby, PA)
- …as it relates to proper processing and accuracy of patient stay claims data, denials management, and appeals . Assists RN Manager with establishing tools, ... Care Coordination Manager, provides support to the utilization management, denials and appeals process for the THMA...for RAC requests + Ensures timely review of all clinical denials issued by third party payors… more
- Actalent (Knoxville, TN)
- Job Title: Clinical Appeals Nurse Job Description The Clinical Appeals Nurse is responsible for managing clinical appeals and state ... states. This role involves reviewing and completing both provider and member clinical appeals within designated timeframes, preparing State Hearing packets, and… more
- Cleveland Clinic (Weston, FL)
- …clinical information to the payer, UM data collection and reporting, concurrent denials appeals process, clinical team interaction, Physician Adviser ... an accredited school of nursing with licensure as a Registered Nurse ( RN ) in the...Hospital experience is preferred. *Requires three years equivalent full-time clinical experience as a Registered Nurse… more
- Centene Corporation (New York, NY)
- …medical necessity appeals and denials including disposition of denials notification letters, review of clinical information to determine if medical ... creating new policies to satisfy NCQA and contractual requirements. **Education/Experience:** NYS RN with 2+ years of clinical nursing experience. Proficient… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Utilization Management services to its clients. The Utilization Review Appeals Nurse performs daily appeal reviews and clinical quality oversite. This ... analyze denials of initial preservice medical necessity denials using nationally recognized clinical criteria and...and Complex Care Needs. Essential Qualifications + Current licensed Registered Nurse ( RN ) with state… more
- Stanford Health Care (Palo Alto, CA)
- …**This is a hybrid Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN ) will be responsible for ensuring the ... Stay current with regulatory policies and guidelines related to clinical appeals . + Apply regulatory knowledge to...other healthcare software. **Licenses and Certifications** + Nursing / RN - Registered Nurse -… more
- Hartford HealthCare (Southington, CT)
- …improve clinical documentation **Ensures standard work minimizes risk for denials **Participates in quality assurance audits, audits, appeals and committees ... their clients' families. Basic Purpose of the Position: **Manages appeals at the branch level including clinical ...schedule to meet the needs of the agency. Licensure: Registered Nurse with a license to practice… more
- Billings Clinic (Billings, MT)
- …Licenses * Healthcare Provider CPR Certification At hire * Current Montana license as a Registered Nurse At hire * Current working knowledge of payer and managed ... and/or continued stay *Proactively interacts with payers and proactively sends clinical reviews to prevent inpatient denials *Proactively communicates with… more
- Sharp HealthCare (San Diego, CA)
- …**Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** California Registered Nurse ( RN ) - CA Board of Registered Nursing; ... or equivalent experience in the healthcare setting. + California Registered Nurse ( RN ) - CA...advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials , input into appeals , share findings with… more
- UNC Health Care (Chapel Hill, NC)
- …communities we serve. RN Utilization Manager position specifically for a Utilization Manager/ Clinical Appeals Nurse . This person is based at the Hedrick ... of employment date. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North Carolina. **Professional… more
- Hackensack Meridian Health (Edison, NJ)
- …and utilization management **Licenses and Certifications Required** : + NJ State Professional Registered Nurse License + AHA Basic Health Care Life Support HCP ... team and is responsible for coordinating, communicating, and facilitating the clinical progression of the patient's treatment. Accountable for a designated patient… more
- Alameda Health System (Alameda, CA)
- …health preferred.** **Required Licenses/Certifications:** **Valid license to practice as a Registered Nurse in the State of California.** **Required ... AHD Case Manager RN + Alameda, CA + Alameda Hospital +...action when cases do not meet criteria - coordinates denials with the attending physician, and the UR physician… more
- Highland General Hospital (Alameda, CA)
- …health preferred. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. Required Licenses/Certifications: ... Role Overview: The AHD Case Manager ( RN ) is responsible for providing comprehensive case management...action when cases do not meet criteria - coordinates denials with the attending physician, and the UR physician… more
- University of Michigan (Ann Arbor, MI)
- …with providers + Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials ; input into appeals ; share findings with providers + Review all ... RN CASE MANAGER: University Hospital (Care Management) Apply...areas. The position is unique in that it combines clinical /quality considerations with regulatory/financial/utilization review demands. The position creates… more
- LifePoint Health (Pulaski, TN)
- …in statistical tracking and reporting of the Utilization Management metrics. Facilitates appeals of denials as needed, including analysis and corrective actions ... of care for each patient, including participation in the Clinical Documentation Program Facilitate Discharge Planning through team collaboration...for denials due to those processes within the scope of… 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 ... to ensure accurate, timely, compliant documentation that drives accurate billing Qualifications + Clinical review positions will require a RN degree in nursing… more
- Montrose Memorial Hospital (Montrose, CO)
- …letter writing, eg, appeals , preferred. + Must at least be Licensed as a Registered Nurse in the State of Colorado or possess a Compact State License. + ... to reduce financial risk and exposure caused by concurrent and retrospective denials . The Clinical Denial Analyst is considered a clinical expert in Denial… more