• Clinical Denials Specialist

    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
    Insight Global (10/04/24)
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  • Registered Nurse RN Case…

    AdventHealth (Winter Garden, FL)
    …for the mind, body, and spirit! **The role you'll contribute:** The RN Care Manager in collaboration with the patient/family, social workers, nurses, physicians, ... care coordination and progression through the continuum of care. The RN Care Manager ensures efficient and cost-effective care through appropriate resources… more
    AdventHealth (10/11/24)
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  • Utilization Management Coordinator (contingent)

    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
    Trinity Health (10/09/24)
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  • Outpatient Denial/Appeals Specialist

    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 Cycle...REQUIREMENTS Bachelor's Degree in Nursing CERTIFICATION & LICENSURE REQUIREMENTS Registered Professional Nurse ( RN ) License… more
    Carle (08/23/24)
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  • RN -Denial Reviewer- remote

    PeaceHealth (Vancouver, WA)
    …DRG-downgrade denials in the inpatient acute care setting Credentials + Required: Registered Nurse In state of practice or + Required: Certified Clinical ... **Description** PeaceHealth is seeking a RN Clin Doc Integrity Specialist /Denial Reviewer...adult medicine. (Required) Department / Location Specific Notes Additional Registered Nurse licensure may be required within… more
    PeaceHealth (10/01/24)
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  • RN Care Manager

    AdventHealth (La Grange, 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
    AdventHealth (08/13/24)
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  • Utilization Review Specialist Senior

    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
    BayCare Health System (10/14/24)
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  • Prior Authorization Specialist - Inpatient…

    Select Medical (West Orange, NJ)
    …authorization of referrals scheduled for admission to the acute inpatient rehabilitation hospital. + Registered Nurse ( RN ) or Licensed Practical Nurse ... and denials through TOC. **Qualifications** **Minimum Qualifications** + Licensure as a Registered Nurse or LVN/LPN is required + 2 years of direct… more
    Select Medical (09/07/24)
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  • Clinical Documentation Integrity Specialist

    Carle (Urbana, IL)
    …EDUCATIONAL REQUIREMENTS Associate's Degree in Nursing or Doctorate CERTIFICATION & LICENSURE REQUIREMENTS Registered Nurse ( RN ) Illinois or Registered ... Clinical Documentation Integrity Specialist + Department: Health Information Management + Entity:...peers and providers we needed or requested. Reviews DRG denials and provides information to the denials more
    Carle (10/15/24)
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  • Care Manager RN

    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
    AdventHealth (11/02/24)
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  • Utilization Management Specialist NE

    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
    Cleveland Clinic (10/31/24)
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  • Care Transition Manager RN - Care…

    Texas Health Resources (Rockwall, TX)
    …an acute care hospital required and * 1 year in discharge planning/care management preferred * RN - Registered Nurse required upon hire and * CPR - ... **Care Transition Manager RN - Care Management PRN Days** _We are...to schedule follow up appointments with either a PCP, specialist , clinic, visiting physician or other transitional care visit… more
    Texas Health Resources (09/20/24)
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  • CDI Specialist

    Granville Health System (Oxford, NC)
    …Required:#Graduate from a Board approved nursing program with current licensure as a registered nurse in the state of North Carolina required; #Familiarity with ... 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
    Granville Health System (09/05/24)
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  • Appeals Audit Specialist - McLaren Careers

    McLaren Health Care (Bay City, MI)
    …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 ... other related duties as required and directed. **Qualifications:** **_Required:_** + Registered Health Information Technician (RHIT), Licensed Practical Nurse more
    McLaren Health Care (09/26/24)
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  • Manager ( RN ), Clinical Documentation…

    University of Washington (Seattle, WA)
    …to identify improvement opportunities **REQUIREMENTS** + Current license to practice as a Registered Nurse in the State of Washington + At least 6 ... here.** **UW Medical Center** has an outstanding opportunity for an **CLINICAL DOCUMENTATION MANAGER ( RN )** . **WORK SCHEDULE** + 100% FTE + Monday - Friday + Remote… more
    University of Washington (10/04/24)
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  • Medical Records Technician (Clinical Documentation…

    Veterans Affairs, Veterans Health Administration (Sioux Falls, SD)
    …two years of experience in clinical documentation improvement; OR, Clinical experience, such as Registered Nurse ( RN ), Medical Doctor (MD), or Doctor of ... and supported. Such efforts are conducted to ensure the accuracy of billing denials and prevention against fraud and abuse and to optimize the medical center's… more
    Veterans Affairs, Veterans Health Administration (11/01/24)
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  • Payor Relations Specialist - Inpatient…

    Select Medical (Peoria, AZ)
    …14. Performs other duties as requested. **Qualifications** **Minimum Qualifications** + Licensure as a Registered Nurse or LVN/LPN is required + 2 years of of ... with Select Medical & Banner Health Phoenix, Arionza **Payor Relations Specialist ** **Remote position** **Schedule is Monday through Friday plus weekend rotation… more
    Select Medical (11/01/24)
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  • Housing Specialist

    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
    Project Renewal, Inc. (08/23/24)
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  • Utilization Management Specialist

    Sanford Health (MN)
    …for Nursing Commission for Nursing Education Accreditation (NLN CNEA). Currently holds an unencumbered registered nurse ( RN ) license with the State Board of ... chart review, and assisting with and managing of insurance coverage and denials , prior authorizations, scheduled procedures, same-day readmission reviews, as well as… more
    Sanford Health (11/02/24)
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  • Revenue Integrity Specialist / Revenue…

    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
    Hartford HealthCare (10/11/24)
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