- R1 RCM (Salt Lake City, UT)
- …platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Coding Appeals Nurse ** , you ... this remote production-drive position. **Here's what you will experience working as a Clinical Coding Appeals Nurse :** + Review and interpret medical… more
- HCA Healthcare (San Antonio, TX)
- …our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Clinical Appeals Nurse RN with Parallon you can be a part ... in our organization. We are looking for an enthusiastic Clinical Appeals Nurse RN to...root cause of each denial and apply company specific coding for trending and analysis. Update the patient account… more
- LA Care Health Plan (Los Angeles, CA)
- …with Registered Nurses and Medical Directors to appropriately investigate, review and resolve clinical appeals and grievances. Prepares Nurse Summary for MD ... Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical...of resolution letters. Reviews grievance cases that require immediate clinical quality of care, initial coding of… more
- Trinity Health (Farmington Hills, MI)
- …and determining root causes of clinical denials. Responsible for leveraging clinical knowledge and standard procedures to track appeals through first, ... best practices. The position will report directly to the Supervisor Clinical / Coding Payment Resolution. **ESSENTIAL FUNCTIONS** Knows, understands,… more
- CVS Health (Hartford, CT)
- …years of clinical experience Preferred Qualifications Medicare experience Appeals Experience Coding Experience Utilization Review experience Education ... for this role are Monday-Friday 8a-5p. Position Summary The Appeals Nurse Consultant position is responsible for...in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates… more
- Northwell Health (Melville, NY)
- …stay. Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately ... as a resource for the Health System. Reviews denial trends and identifies coding issues and knowledge gaps. Job Responsibility Serves as liaison between the patient… more
- Trinity Health (Farmington Hills, MI)
- …timeliest manner possible: + Coordinates follow-up activities with Utilization Review/Case Management/ Coding / Nurse Liaison to provide required clinical ... location. The scope of responsibility will be all post-billed denials (inclusive of clinical denials). Serves as part of the Payment Resolution team at an assigned… more
- Trinity Health (Farmington Hills, MI)
- …timeliest manner possible: + Coordinates follow-up activities with Utilization Review/Case Management/ Coding / Nurse Liaison to provide required clinical ... of responsibility will be all post-billed denials (inclusive of clinical denials). Serves as part of a team of...state/federal laws as they relate to contracts and the appeals process. Assists in training Payment Resolution Specialist I… more
- BrightSpring Health Services (Louisville, KY)
- Our Company BrightSpring Health Services Overview The Clinical Coding and Audit Specialist monitors, responds and performs the clinical coding and audit ... position will also support detailed level reporting and analytics, clinical appeals , root cause analysis, and address...a current license/registration by state of hire as a nurse + Successfully completed HCS-D coding certification,… more
- Trinity Health (Darby, PA)
- …time **Shift:** Day Shift **Description:** Trinity Health Mid-Atlantic is looking for Clinical Pre-Service Nurse Coordinator to join our Pre-Service team! ... be on location at 41 University Drive Newtown, PA 18940. **Summary:** The Clinical Pre-Service Nurse Coordinator is directly responsible for reviewing pre/post… more
- Martin's Point Health Care (Portland, ME)
- …services requiring clinical review prior to payment. The Utilization Review Nurse will use appropriate governmental policies as well as specified clinical ... , and other compliance, or reimbursement related issues. Responsible for leveraging clinical and/or coding experience to perform facility and provider medical… more
- Centers Plan for Healthy Living (Brooklyn, NY)
- …+ Strong communication skills. + Building relationships + Working knowledge of clinical documentation requirements & Medicare Risk Adjustment coding Preferred: ... Nurse Practitioner - ISNP (Full-Time) Brooklyn, NY, USA...Reviews and manages pharmacotherapy of each member, collaborating with clinical pharmacist and physicians when necessary. + Prescribe appropriate… more
- Stanford Health Care (Palo Alto, CA)
- …medical necessity. + Stay current with regulatory policies and guidelines related to clinical appeals . + Apply regulatory knowledge to strengthen appeal cases. + ... Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN) will be responsible for ensuring the efficient and effective… more
- Sharp HealthCare (San Diego, CA)
- …Day **FTE** 1 **Shift Start Time** **Shift End Time** California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians; Other ... care. **Required Qualifications** + Other : Graduate of an accredited Licensed Vocational Nurse (LVN) program + 3 Years experience in the acute patient care and/or… more
- Apex Health Solutions (Houston, TX)
- …carrying out day today pre-authorization functions. The Utilization Review Nurse will also be responsible for issuing pre-authorization approvals/denials, notifying ... prospective review/precertification requirements. *Collects and/or documents all required enrollee clinical and co-morbidity information during the pre-authorization process to… more
- Cleveland Clinic (Weston, FL)
- …information to the payer, UM data collection and reporting, concurrent denials appeals process, clinical team interaction, Physician Adviser interaction, and ... *Prior RN Hospital experience is preferred. *Requires three years equivalent full-time clinical experience as a Registered Nurse required. *Knowledge of medical… more
- Cleveland Clinic (Stuart, FL)
- …information to the payer, UM data collection and reporting, concurrent denials appeals process, clinical team interaction, Physician Adviser interaction, and ... year of eligibility. **Work Experience:** + Requires three years equivalent full-time clinical experience as a Registered Nurse . + Prior Utilization Management… more
- Sharp HealthCare (San Diego, CA)
- …Day **FTE** 0 **Shift Start Time** **Shift End Time** California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians; Other ... care. **Required Qualifications** + Other : Graduate of an accredited Licensed Vocational Nurse (LVN) program. + California Licensed Vocational Nurse (LVN) - CA… more
- Virtua Health (Berlin, NJ)
- …billing process.* Maintains open communication with management regarding billing and coding issues including documentation, denials/ appeals , etc.* Follows up on ... over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques… more
- UNC Health Care (Chapel Hill, NC)
- …the unique communities we serve. RN Utilization Manager position specifically for a Utilization Manager/ Clinical Appeals Nurse . This person is based at the ... Hedrick building and is 100% on-site. This individual combines clinical , business, and regulatory knowledge to reduce significant financial risk caused by concurrent… more