- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the ... and denials for no authorization. The Senior Denials Management Specialist position communicates...nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… 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
- 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
- Community Health Systems (Franklin, TN)
- …+ CRNP, LPN, RN , MD, PA, or DO preferred + CCS-Certified Coding Specialist required or + RHIT - Registered Health Information Technician required or + ... **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits...Medical Coding Program preferred + Associate Degree Health Information Management or related field preferred + 3-5 years Inpatient… more
- Houston Methodist (Houston, TX)
- …in utilization review and/or case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact ... At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered ...functions through point of entry, observation progression of care management , concurrent review and denials reviews. Additionally,… more
- Penn Medicine (Lancaster, PA)
- …General Health is looking for an experienced RN to join our Utilization Management Specialist team! In this critical role, you'll advocate for patients by ... love to hear from you!_ **Summary** : The Utilization Management Specialist - Admissions is responsible for...assigned. **Minimum Required Qualifications:** + Current licensure as a Registered Nurse , issued by the Pennsylvania Board… more
- St. Luke's University Health Network (Allentown, PA)
- …Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. . ... a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews...and procedure code assignment and MS-DRG/APR-DRG accuracy based on denials or audit findings from government and commercial payers.… more
- Hartford HealthCare (Farmington, CT)
- … management and appeals preferred. **Licensure, Certification, Registration** * Active Registered Nurse license from the State of Connecticut * Certified ... Denial Specialist is responsible for reviewing, analyzing and appealing denials related to DRG (Diagnostic Related Group) downgrades. This role involves… more
- Carle Health (Urbana, IL)
- …assists the team for timely planning and collaboration. Qualifications Certifications: Licensed Registered Professional Nurse ( RN ) - Illinois Department of ... 1 year of nursing experience Responsible for the oversight, coordination, and management of the functional and financial outcomes during acute illness requiring… more
- PeaceHealth (Bellingham, WA)
- …Review experience, someone who can talk to providers. **Credentials** + Required: Registered Nurse in state of practice + Preferred: Psychiatric/Mental Health ... **Description** PeaceHealth is seeking a RN Admissions/Utilization Behavioral Health - Care Management...Clinical Nurse Specialist **Skills** + Strong psychiatric nursing… more
- BayCare Health System (Tampa, FL)
- …Call:** No **Certifications and Licensures:** + Required RN ( Registered Nurse ) + Preferred ACM (Case Management ) + Preferred CCM (Case Manager) ... or + Required 2 years in Case Management or + Required 3 years Registered Nurse + Preferred experience in Critical Care or Emergency Service **Benefits:** +… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Clinical Documentation Integrity Specialist , Clinical Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the ... to be named a Forbes "Best Employer" seven times. Position Summary: The CDI Specialist serves as a liaison between the physicians and hospital departments to promote… more
- St. Peters Health (Helena, MT)
- The Utilization Management RN reports directly to Utilization Review RN Coordinator. The UR RN supports the UR RN Coordinator and other UR team ... peer calls for both hospital admissions and for specific outpatient service denials as assigned, and participation in the organizations Utilization Review Committee.… 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 Southern California (Arcadia, CA)
- …impact DRG assignments. + Minimum of three years' experience in clinical disciplines ( RN , MD, FMG) or utilization review/case management in an acute care ... (Required) + Graduate from a program of nursing, BSN, Health Information Management RHIT, RHIA, or foreign medical doctorate degree strongly preferred. + Accredited… more
- Hartford HealthCare (Farmington, CT)
- …now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system. ... Business Office in Newington. *_Position Summary:_* The Revenue Integrity Specialist determines the appropriateness of patient charges, and Charge Description… more
- Carle Health (Champaign, IL)
- … Association (AHIMA)American Health Information Management Association (AHIMA); Licensed Registered Professional Nurse ( RN ) - Illinois Department of ... nurses, ancillary staff, and the coders in Health Information Management to identify and record principal and secondary diagnoses,...peers and providers we needed or requested. Reviews DRG denials and provides information to the denials … more
- AnMed Health (Anderson, SC)
- …position is responsible for performing the daily operations of the Utilization Management program at AnMed within the Care Coordination model. These duties include ... necessity review, continued stay/concurrent review, retrospective review, bed status management , resource utilization management , regulatory compliance, and… more
- UnityPoint Health (Cedar Rapids, IA)
- …Overview This position is on site at St. Luke's Hospital. The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments serves a ... clinical outcomes and patient and provider satisfaction. The UM Specialist provides the Utilization Management function for...to quality care, effective utilization of resources and pursues denials of payment and referrals in a timely, legible… more
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