- BroadPath Healthcare Solutions (Tucson, AZ)
- …seeking a highly motivated and results-driven ** UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical ... directors/physician reviewers, network physicians, and network facilities to ensure consistent clinical evaluation and processing of medical necessity appeals .… more
- Alameda Health System (Oakland, CA)
- …background. Required Licenses/Certifications : Valid license to practice as a Registered Nurse in the State of California. Preferred Licenses/Certifications ... of quality improvement initiatives. Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals… more
- Centene Corporation (Salem, OR)
- …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
- Cedars-Sinai (Beverly Hills, CA)
- …Angeles Fair Chance Initiative for Hiring. **Req ID** : 12949 **Working Title** : Registered Nurse - ISP Care Coordinator - PER_DIEM 8 Hour Days **Department** ... care. Use Milliman and Interqual guidelines as necessary. + Collaborates with clinical teams and practices to ensure synchronization of sub-areas' operations to… more
- Corewell Health (Grand Rapids, MI)
- … clinical nursing and or case management/managed care or related field Preferred + Registered Nurse ( RN ) - State of Michigan Upon Hire required + ... (4 hours), mostly remote, occasional on-site About the Department: RN UM - Supporting the insurance coordination...insurance prior authorizations, initial reviews, continuous stay reviews and appeals . Nurse Care Manager - Plans and… more
- Molina Healthcare (Orem, UT)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… 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
- UnityPoint Health (Cedar Rapids, IA)
- …care, optimal clinical outcomes and patient and provider satisfaction. The UM Specialist provides the Utilization Management function for patients admitted to BH ... with physicians, third party payers and regulatory agencies. The UM spcialist will also be called upon to provide... spcialist will also be called upon to provide clinical and nursing expertise and support within the HOD… more
- Nuvance Health (Danbury, CT)
- …or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience in an acute care setting * ... for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while partnering...ensure CMS and regulatory compliance.* *Develop and maintain a UM plan to guide the team with detailed processes… more
- Saint Francis Health System (Tulsa, OK)
- …field. Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License, or Clinical Social Worker (LCSW), ... through Friday, 8:00 am to 5:00 pm** Job Summary: Provides administrative and clinical support to the hospital and treatment team throughout the review of patients,… more
- Alameda Health System (Oakland, CA)
- …nursing background. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. Preferred ... of quality improvement initiatives. + Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals .… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …up to*Every Other Weekend*coverage/. *_SPECIFIC RESPONSIBILITIES:_* The Utilization Review (UR) Registered Nurse is responsible for evaluating the medical ... initiatives *Education*: * Attains and maintains current knowledge in UR/ UM practices, payer requirements, clinical guidelines, and.../*License/Certifications:*/ * Possession of a valid license as a Registered Nurse issued by the State of… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …TITLE: Utilization Review Clinician PAY RANGE: LVN/LPT $31.50-37.50 Per Hour RN /LCSW/LMFT/LPCC $54.00-64.00 Per Hour REPORTS TO: Director of Utilization Review ... ensure that extended stays are medically justified. + Payment Appeals : Prepare and submit appeals to third...Treatment Team on a daily basis and collaborate with clinical team to answer clinical questions related… more
- MVP Health Care (Schenectady, NY)
- …York** **Qualifications you'll bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 ... maintain cost-effectiveness and manage Medical Loss Ratio (MLR). + Appeals & Denials: Participate in the appeals ...+ Training & Support: Educate staff and providers on UM protocols, documentation standards, and clinical guidelines.… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …as assigned. Essential Qualifications * Current Licensed Practical Nurse (LPN) or Registered Nurse ( RN ) with state licensure. Must retain active and ... care. * Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed. *...within managed care setting. * 3+ years' experience in clinical nurse setting preferred. * TPA Experience… more
- Huron Consulting Group (Chicago, IL)
- …Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new ... partnerships, clinical services and technology is not enough to create...Improvement: Provides analysis and reports of utilization, denials, and appeals KPIs, trends, patterns, and impacts to resources. Tracks,… more
