- R1 RCM (Boise, ID)
- …to escalate trends, challenges, and process improvement opportunities. **Required Skills:** + Registered Nurse (active or inactive in good standing and able ... analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals and Denials Manager** , you will serve as an expert on clinical… more
- Dayton Children's Hospital (Dayton, OH)
- …Coaching Skills preferred Education Requirements: Bachelors: Nursing (Required) Certification/License Requirements: [Lic] RN : Registered Nurse ( RN ) - ... Education + Completion of accredited BSN program required Certifications + Licensed Registered Nurse in Ohio required + Current professional certification in… more
- McLaren Health Care (Bay City, MI)
- …and responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met ... other related duties as required and directed. **Qualifications:** **_Required:_** + Registered Health Information Technician (RHIT), Licensed Practical Nurse … more
- BronxCare Health System (Bronx, NY)
- …special projects and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate ... Assists in the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care… more
- WellSpan Health (York, PA)
- …Required + 3 years Utilization Management Experience. Preferred Licenses: + Licensed Registered Nurse Preferred Knowledge, Skills, and Abilities: + Advanced ... Responsibilities + Oversees the utilization management process for preauthorization, concurrent review, denials and appeals for System acute care facilities. +… 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 ... leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical support staff while partnering with… more
- R1 RCM (Detroit, MI)
- …identify targeted areas for additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay ... will help support clinicians who conduct a comprehensive review of clinical denials and formulate appeals based on clinical documentation, evidence-based medical… 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 ... to optimize patient outcomes and manage healthcare costs. 4. Denials and Appeals Management: Address and manage...other healthcare software. **Licenses and Certifications** + Nursing / RN - Registered Nurse -… more
- Ascension Health (Manhattan, KS)
- …rules and regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Kansas Board of Nursing ... related to coding, medical records/documentation, precertification, reimbursement and claim denials / appeals . + Assess and coordinate discharge planning needs… more
- Brockton Hospital (Brockton, MA)
- …responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is ... external review agencies, to coordinate activities involved in medical record review, denials , appeals and reconsideration hearings. Works closely with the… 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 ... clinical information to the payer, UM data collection and reporting, concurrent denials appeals process, clinical team interaction, Physician Adviser interaction… more
- Highmark Health (Harrisburg, PA)
- …and contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials / appeals and retrospective payer audit denials . ... **Preferred** + None **EXPERIENCE** **Required** + 2 years of recent clinical RN Acute care, Home care, Palliative, Hospice, or Care Management **Preferred** +… more
- Crouse Hospital (Syracuse, NY)
- …and organization. + EDUCATION / CERTIFICATION / LICENSURE + Required: + Licensed as a Registered Nurse in New York State. + Bachelor's Degree + EXPERIENCE + ... responsible for providing day to day management of the RN Care Managers in the department. + The areas...compliance. The Manager works closely with the UM and Appeals and Denials staff as both areas… more
- Glens Falls Hospital (Glens Falls, NY)
- …Unit (BHU)! Glens Falls Hospital is seeking a strategic, forward thinking, and motivated Registered Nurse with leadership experience to join as our next Nurse ... role is for you! *Team Impact* As the Clinical Nurse Manager, you will provide overall clinical and operational...charge review * Serve as a clinical resource for appeals and denials * Review/update of Charge… more
- Ascension Health (Austin, TX)
- …rules and regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Texas Board of Nursing or ... related to coding, medical records/documentation, precertification, reimbursement and claim denials / appeals . + Assess and coordinate discharge planning needs… more
- Ascension Health (Milwaukee, WI)
- …management rules and regulations. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Wisconsin Board of Nursing ... related to coding, medical records/documentation, precertification, reimbursement and claim denials / appeals . + Assess and coordinate discharge planning needs… more
- Providence (Mission Hills, CA)
- …+ Bachelor's Degree in Nursing or other related area + Upon hire: California Registered Nurse License + 5 years Healthcare management experience related to acute ... may consider in lieu of acute care + Previous experience working with denials and appeals in/for an acute care setting + Previous experience working with a… more
- Ascension Health (Glendale, WI)
- …and identify savings potential. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Wisconsin Board of Nursing ... Connect with your Talent Advisor for additional specifics._ **Responsibilities** Coordinate payer denials and appeals , respond to insurance company requests for… more
- UNC Health Care (Chapel Hill, NC)
- …of employment date. **Licensure/Certification Requirements:** * Licensed to practice as a Registered Nurse in the state of North Carolina. **Professional ... Protects hospital revenue by working with payors for insurance authorizations, denials , and appeals + 40 hrs/week with flexible schedule options available +… more
- Carle (Urbana, IL)
- …Work Location: Working from Home + Weekend Requirements: no + Other Posting Information: Registered Professional Nurse ( RN ) License Illinois upon hire. + ... Outpatient Denial/ Appeals Specialist- RN + Department: Revenue...REQUIREMENTS Bachelor's Degree in Nursing CERTIFICATION & LICENSURE REQUIREMENTS Registered Professional Nurse ( RN ) License… more