- Insight Global (Skokie, IL)
- Job Description Insight Global is looking for a clinical denials specialist to join the team at one of your healthcare clients in Chicago. As a Clinical ... Denials Specialist you will be working with...and Requirements 3+ years experience as a utilization review nurse Experience reviewing and analyzing denied claims Knowledge of… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials ... and tracks outcomes regarding appeal process. Assists billing staff regarding outpatient denials for experimental, coding or other issues that may require record… more
- AdventHealth (Altamonte Springs, FL)
- …2 years utilizing InterQual and/or MCG . Minimum of three (3) years' experience as Registered Nurse ( RN ) in an acute clinical setting . Clinical experience ... contribute:** This position is responsible for investigating and appealing post-remit denials for all Inpatient and Outpatient clinical services across the system,… more
- AdventHealth (Daytona Beach, FL)
- …or RN Diploma degree + State of Florida license as a Registered Nurse + Two (2) years of medical/hospital nursing experience **Preferred qualifications:** ... Medical Parkway, Daytona Beach, FL 32117 **The role you'll contribute:** The RN Care Manager in collaboration with the patient/family, social workers, nurses,… more
- Trinity Health (Pontiac, MI)
- …medical record. 10 Participates in the appeal process when deemed necessary by the Denials Management Specialist on cases where payment has been denied. **Our ... Degree in Nursing preferred . **B.** **Licensure / Certification** Current RN licensure within the State of Michigan. Certified Professional in Utilization… more
- Dartmouth Health (Lebanon, NH)
- Overview Clinical Documentation Specialist ( Registered Nurse ) - Full Time Remote 40 hours per week * Clinical Documentation Specialist experience ... documentation. * 3 years of applicable experience. Required Licensure/Certifications - Licensed Registered Nurse with NH eligibility * Remote:Fully Remote; *… more
- BayCare Health System (Clearwater, FL)
- …Critical Care or Emergency Nursing RN . **Certifications and Licensures:** + Required RN ( Registered Nurse ) + Preferred ACM (Case Management) + Preferred ... **BayCare Health System** is currently seeking a **Utilization Review Specialist Senior** to join our outstanding and compassionate team....2 years in Case Management + Preferred 3 years Registered Nurse in Critical Care or Emergency… more
- AdventHealth (Hinsdale, IL)
- …skills **.** Teamwork principles **EDUCATION AND EXPERIENCE REQUIRED:** . Associates Degree Nursing or RN Diploma degree . Registered Nurse ( RN ) . ... **LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:** **.** State of Illinois registered nurse license **LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:**… 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 ... information to the payer, UM data collection and reporting, concurrent denials appeals process, clinical team interaction, Physician Adviser interaction and special… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Clinical Documentation Integrity Specialist Full-Time, 80 Hours per pay period, Day Shift Covenant Health Overview: Covenant Health is the region's ... be named a Forbes "Best Employer" seven times. Position Summary: The CDI Specialist serves as liaison between the physicians and hospital departments to promote… more
- Granville Health System (Oxford, NC)
- …of CDI. Required:# Graduation from a Board-approved nursing program with current licensure as a Registered Nurse ( RN ) or Licensed Practical Nurse (LPN) ... Summary:#The CDI Specialist is responsible for improving the overall quality...of Present on Admission indicators. #Obtains documentation relevant to denials avoidance related to the Recovery Audit program, the… more
- Alameda Health System (San Leandro, CA)
- …at a medical group or health plan. Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California, Active BLS - Basic Life ... Care Management Clinical Appeals Specialist + San Leandro, CA + Finance +...based on identified criteria and ensures the patient is registered at the appropriate level of care; Utilizes McKesson… more
- Project Renewal, Inc. (Bronx, NY)
- …psychiatric services are provided Monday through Friday, staffed by a psychiatrist, nurse practitioner, registered nurse , and a licensed practical ... Housing Specialist Shelter- Ana's Place, 4380 Bronx Blvd, Bronx,...tracking system for submitted applications, interviews, and selections or denials . Performs follow-up to any denial of housing applications… more
- Hartford HealthCare (Farmington, CT)
- …Business Office in Newington. *_Position Summary:_* The Revenue Integrity Specialist determines the appropriateness of patient charges, and Charge Description ... and completeness, following regulatory requirements, in order to resolve edits, denials or exceptions detected during system processing of the claim. *_Position… more
- Munson Healthcare (Traverse City, MI)
- …required to obtain a BSN within 5 years of start date. + Current licensure as Registered Nurse in the State of Michigan. + Minimum of three years clinical ... Updates all involved parties regarding potential, threatened or actual denials due to lack of medical necessity or barriers...external case managers Why work as a Utilization Review Specialist at Munson Healthcare? + Our dynamic work environment… more
- Hackensack Meridian Health (North Bergen, NJ)
- …and serve as a leader of positive change. The **Care Coordination Specialist ** performs selected services and functions related Transitions of Care & Utilization ... **Responsibilities** A day in the life of a **Care Coordination Specialist ** at **Hackensack Meridian** **_Health_** includes: **Utilization Management** + Payer… more
- Baptist Memorial (Memphis, TN)
- Summary Authorization Denial Specialist ensures that chemotherapy (specialty group) and other infusions/radiation therapy/radiology/ surgical services meet medical ... and supporting documentation for outpatient or Part B services authorization denials to determine and perform retro authorizations, reconsiderations or appeal… more
- CaroMont Health (Gastonia, NC)
- …physicians regarding utilization issues. Collaborates with discharge planning specialist and other disciplines. Retrospectively reviews discharged medical record ... management as necessary. Retrospectively reviews medical record for clinical denials . Composes a detailed summary of care and sends...clinical reviews/appeals as part of denial process. The UR Specialist will be cross trained to work for the… more
- Health First (Rockledge, FL)
- …Management* **Organization:** **HF Administrative Plan Inc* **Title:** *Prior Authorization Nurse Specialist HFHP - Clinical Operations* **Location:** *Florida ... Medical Management Systems and approves or refers to Medical Director potential denials and documents in the Medical Management system per established protocols. *… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …20 years of experience as an intensive care unit, emergency department or documentation specialist nurse auditor or an LPN with a combined coding and auditing ... Summary With direction from the Patient Financial Services Director, the Nurse Auditor/ Revenue Integrity/ CDM Analyst is responsible for performing audits of… more