- Beth Israel Lahey Health (Plymouth, MA)
- …making a difference in people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who We Are:** At **Beth ... Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager, you will:** + Directs staff performance regarding UR and… more
- Houston Methodist (Sugar Land, TX)
- …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical… more
- UNC Health Care (Kinston, NC)
- …preferred. + **EXPERIENCE** + Minimum 3-5 years of applied clinical experience as a Registered Nurse required. + 2 years utilization review, care management , ... or compliance experience preferred. + Minimum 1 year clinical denials management preferred. + **LICENSURE/REGISTRATION/CERTIFICATION** + Licensed to practice as… more
- Nuvance Health (Danbury, CT)
- …and trending all appeals and communicating on a daily/regular basis with the Denials Management team. * Assists with informing Managed Care contracting team ... This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to...required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting… more
- Nuvance Health (Danbury, CT)
- …in nursing, health administration, or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience ... and strategy for system-wide care coordination, encompassing utilization review (UR), denials management , discharge planning, social work, and non-clinical… more
- Crouse Hospital (Syracuse, NY)
- … of the RN Care Managers in the department, including Utilization Management , Discharge Planning and Denials and Appeals functions. + Assessing workflow ... Office staff regarding workflow processes and maintains an effective denials management process. + General operational oversight...agreements. Care Coordination Manager Requirements: + Licensed as a Registered Nurse in New York State +… more
- Houston Methodist (Houston, TX)
- …leading multi-site or enterprise-level programs preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... exposure to confidential/sensitive information + Proven expertise in throughput optimization, denials management , and team leadership across diverse care… more
- HealthTrust Workforce Solutions (Nashville, TN)
- …access to more than 200,000 jobs nationwide. **_JOB SUMMARY_** The Interim Leader of Case Management Services is a Registered Nurse who participates as an ... and resource management , cost control, contract compliance, quality improvement, utilization management , denials management and management of… more
- Carle Health (Champaign, IL)
- …with or by the authorization of the Chief Medical Officer and works with our Utilization Management RN team, Clinical Denials Management team and the ... and ad hoc meetings related to utilization management , case management and clinical denials management . + The Behavioral Health Physician Advisor is also… more
- Rady Children's Hospital San Diego (San Diego, CA)
- … management process for acute inpatients. Case Managers perform concurrent review and denials management based on acute care guidelines with a focus on ... of care. MINIMUM QUALIFICATIONS: BLS for Health Providers (American Heart Association) California RN License Bachelor's Degree in Nursing 4 years nursing in an acute… more
- McLaren Health Care (Mount Pleasant, MI)
- …and Responsibilities as Assigned:** 1. Supports activities consistent with Integrated Care Management Denials across all MHC subsidiaries. 2. Accountable for ... responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and… more
- University of Washington (Seattle, WA)
- …changes impacting revenue cycle **REQUIREMENTS** + Active licensure to practice as a Registered Nurse in Washington State + Bachelor's degree in Nursing + ... an outstanding opportunity for a **Clinical Appeals and Disputes Nurse .** **WORK SCHEDULE** + 100% FTE + 100% Remote...required in one of the following areas: clinical, case management , denials , billing + Familiarity with National… more
- Houston Methodist (Houston, TX)
- …with HM performance that demonstrates leadership responsibility **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... At Houston Methodist, the Director Case Management & Social Services RN position...of opportunities for appropriate utilization of resources to avoid denials and resource management as it pertains… more
- Cognizant (Salem, OR)
- …expectations. **What you need to have to be considered** + Educational background - Registered Nurse ( RN ) + 2-3 years combined clinical and/or utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...by performing advanced level work related to clinical denial management and managing clinical denials from Providers… more
- Geisinger (Scranton, PA)
- …theft protection, universal life and pet and legal insurance Position Details The Registered Nurse Care Manager works with physician and multidisciplinary team ... Experience Minimum of 3 years-Nursing (Required) Certification(s) and License(s) Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania OUR PURPOSE… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse ( RN ) - Case Manager - 2506003285 Description : Join our dedicated healthcare team where compassion meets innovation! As a Registered ... and is determined by employment status Job Description: The RN Case Manager is responsible to facilitate care along... experience preferred. 3. License to practice as a Registered Nurse in the State of Michigan.… more
- System One (Las Vegas, NV)
- …medical criteria and standards of care Licensure and Certification: + Current, unrestricted Registered Nurse ( RN ), Licensed Social Worker (LSW), or Licensed ... insights into the clinical documentation system for processing approvals and denials , notify care management team of LTSS approvals and denials , and support… more
- Baystate Health (Springfield, MA)
- …Diem Hospital Case Manager** The ** RN Hospital Case Manager** is a registered nurse responsible for the coordination of clinical care, quality, and financial ... interventions for patients at risk for readmissions + Manages concurrent denials and works with physicians to overturn for appropriate reimbursement **Required… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits for both RAC and non-RAC accounts, reviewing patient records for accuracy in ... the denial and appeal status. + Consults with Coordinator and/or Director, Coding Denials and Appeals during any audit discrepancies. + Attends coding education to… more
- Lawrence General Hospital (Methuen, MA)
- Job Description: The RN Care Coordinator is responsible for overseeing the appropriateness of care provided to members of health plans contracted by the hospital and ... held accountable for appropriate financial and clinical outcomes of these patients. The RN Care Coordinator will be assigned to selected areas of the Hospital on… more