- BJC HealthCare (St. Louis, MO)
- …work experience) **Additional Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist with infusion appeals ... government and commercial plans. This individual will be handling clinical denials and sending them to a nurse...clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be… more
- University of Washington (Seattle, WA)
- …**UW Medicine's Patient Financial Services Department** has an outstanding opportunity for a ** Clinical Appeals and Disputes Nurse .** **WORK SCHEDULE** + ... 100% FTE + 100% Remote + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ensures that payers are prepared to reimburse the UW Medicine… more
- TEKsystems (San Bernardino, CA)
- Clinical Appeals Nurse - Revenue Cycle Management We are looking for a Clinical Appeals Nurse to join our Revenue Cycle Management team. In this ... and ability to interpret complex medical records. + Experience in clinical appeals , utilization review, or revenue cycle management. + Excellent attention to… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- Nuvance Health (Danbury, CT)
- …REQUIRED* * *Hybrid/Remote* * *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within ... in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- Nuvance Health (Danbury, CT)
- *Description* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within the first 12-24 hours ... in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- Northwell Health (Melville, NY)
- …+ Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect ... retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and ... stakeholders, without breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit projects and other… more
- McLaren Health Care (Mount Pleasant, MI)
- …outcomes and fulfills the obligation and responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer ... + Certified Medical Coder, Certified in Healthcare Compliance, Certified Coding Specialist , or Certified Clinical Documentation Specialist certifications more
- TEKsystems (San Bernardino, CA)
- Description We are seeking a dedicated Clinical Appeals Nurse to join our Revenue Cycle Management team. The ideal candidate will be responsible for managing ... support appeals , and following up on submitted appeals . The Clinical Appeals Specialist will work closely with a team of Licensed Vocational Nurses… more
- Beth Israel Lahey Health (Cambridge, MA)
- …to the Director of Quality & Patient Safety, the Quality and Patient Safety nurse specialist plays a role in reviewing publicly reported quality data by ... reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review...prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- Houston Methodist (Sugar Land, TX)
- …management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of care for ... and billing processes, managed care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of CPT and ICD… more
- CaroMont Health (Gastonia, NC)
- …for promoting and monitoring safe, high-quality, cost-effective healthcare with the best clinical outcomes possible. Provide physician and nurse education to ... and reporting. Perform data collection and analysis, trend identification for assigned clinical outcomes, and present this data at the appropriate meetings as… more
- UNC Health Care (Kinston, NC)
- … denials for validity and probability to overturn, proactively gathers required clinical documentation and formulates appropriate appeals . Coordinates with the ... win rates. 12. Assists in documentation review in the clinical documentation specialist role when needed. Working...preferred. + **EXPERIENCE** + Minimum 3-5 years of applied clinical experience as a Registered Nurse required.… more
- State of Colorado (Pueblo, CO)
- …leadership regarding nursing directives using effective communication. Collaborates with the Clinical Safety Specialist (CSS) supervisor in the event of ... Nurse Manager- Mid Level Provider - CMHHIP Nursing-...of nursing staff on their assigned unit(s). Job Duties: Management/ Clinical Direction/Supervision: + This position is responsible for the… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5123731) Apply CDOC Registered Nurse ( Nurse I) ... $10,627.00 Monthly Location Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 10/2025 Department Department of Corrections Division Clinical and… more
- State of Colorado (Sterling, CO)
- Nurse Supervisor - Sterling Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5123947) Apply Nurse Supervisor - Sterling Salary $8,369.00 - ... $11,717.00 Monthly Location Sterling, CO Job Type Full Time Job Number Nurse III 30492 10/2025 Department Department of Corrections Division Clinical and… more
- Fairview Health Services (St. Paul, MN)
- …the development of denial reports and other statistical reports. + Collaborates with Clinical Denials Nurse Specialist and Leadership in high-dollar claim ... **Job Overview** The Inpatient Coding Denials Specialist performs appropriate efforts to ensure receipt of...records and coding guidelines to formulate coding arguments for appeals and/or coding guidance for potential re-bills. Maintains a… more
- State of Colorado (Denver, CO)
- CDOC Licensed Practical Nurse (LPN) - DENVER Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5168795) Apply CDOC Licensed Practical Nurse ... treatment plans, employs infection control measures, provides referral to appropriate Clinical Services staff for new arrivals, crisis intervention, interviews and… more
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