- NewYork-Presbyterian (Brooklyn, NY)
- …an average of 60-70 medical/surgical daily admissions that requires risk identification and clinical reviews. A utilization nurse completes no less than 20 ... are listed in the following description. Case Manager - RN - Inpatient Units- Brooklyn Methodist - Days Located...The Case Manager works collaboratively with physicians, social workers, clinical nurses, home care services, and other members of… more
- Harbor Health Services, Inc. (Mattapan, MA)
- …in quality and consistency of decisions. Supervisory responsibilities for UM RN , Quality Analyst, Appeals and Grievances Specialist. Requirements: Bachelor's ... and Appeals , inpatient and outpatient services, medical policy, and clinical claims review In-depth experience of Mass Health and CMS requirements Knowledge… 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** + ... FTE + 100% Remote + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ...cycle **REQUIREMENTS** + Active licensure to practice as a Registered Nurse in Washington State + Bachelor's… more
- Centene Corporation (Little Rock, AR)
- …analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters ... for member and provider clinical appeals and ensure letters are compliant...assigned + Complies with all policies and standards **Education/Experience:** RN with 4+ years of clinical nursing… more
- HCA Healthcare (Salem, VA)
- …TN, TX, UT, VA). Do you want to join an organization that invests in you as a Clinical Appeals Nurse RN ? At Parallon, you come first. HCA Healthcare has ... make a difference. We are looking for a dedicated Clinical Appeals Nurse RN...trends and process improvements. + Currently licensed as a registered nurse ( RN ) in the… more
- BayCare Health System (Clearwater, FL)
- …Qualifications:** + 2 years of experience with case management and/or clinical appeals or claims. + Registered Nurse **Facility:** BayCare Health System, ... team member be working remotely?** Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Clinical Appeals Nurse - Health Plan **Location**… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse ( RN ) Manager, Appeals and Grievances General Operations ( Clinical ) Job Category: Clinical Department: CSC Appeals & ... + Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and… more
- LA Care Health Plan (Los Angeles, CA)
- …the ability to manage multiple training initiatives simultaneously. Licenses/Certifications Required Licensed Registered Nurse ( RN ) - Active, current and ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC ...as assigned. Education Required Associate's Degree in Nursing for Registered Nurses Education Preferred Bachelor's Degree in Nursing for… 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
- Mount Sinai Health System (New York, NY)
- …(CCM, ACM) or Utilization Management preferred. + 7+ years of experience in clinical acute clinical , utilization management, appeals management or related ... + Ensure timely and appropriate communication with payers for authorization, denials, and appeals . + Collaborate with physicians and clinical teams to ensure… more
- CVS Health (Baton Rouge, LA)
- …recommend solutions. In particular responsible for the review and resolution of clinical documentation, clinical complaints and appeals . Reviews ... Must reside in Louisiana Responsible for intake, investigation and resolution of appeals , complaints and grievances scenarios for all products, which may contain… more
- Nuvance Health (Danbury, CT)
- …5-9pm- Rotate Weekends/Evenings* *Summary:* Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician ... to inquiries and facilitates communications with the System Business Office related to appeals , denial and clinical reviews 9. Reviews new denials and appeal… more
- Cognizant (Salem, OR)
- …to be considered** + Educational background - Registered Nurse ( RN ) + 2-3 years combined clinical and/or utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...clinic operations + Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and… more
- Houston Methodist (Sugar Land, TX)
- …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or...care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge… more
- Beth Israel Lahey Health (Cambridge, MA)
- …high reliability processes to reduce serious safety events and improve patient outcomes. The nurse works with clinical staff to review clinical charts, ... skills to prepare various reports to state and federal regulators, insurance appeals , internal correspondence, and clinical summaries for medical peer review.… more
- State of Colorado (Grand Junction, CO)
- Registered Nurse I, RN I - Grand Mesa Youth Services Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5177091) Apply ... Registered Nurse I, RN I...including physical, psychiatric and dental maintenance. Specific Job Duties: Clinical Duties: Initial nursing assessments and triage of requests… more
- State of Colorado (Brighton, CO)
- Registered Nurse I, RN I - Prairie Vista Youth Services Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5171479) Apply ... Registered Nurse I, RN I...including physical, psychiatric and dental maintenance. Specific Job Duties: Clinical Duties: Initial nursing assessments and triage of requests… more
- Corewell Health (Royal Oak, MI)
- …experience in care management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse ( RN ) - State of Michigan License Upon ... criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization… more
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