- Blanchard Valley Health System (Findlay, OH)
- …and procedures for service area. REQUIRED QUALIFICATIONS Current Ohio Licensure as a Registered Nurse Nursing experience 5+ years, 2-4 years in Care Coordination ... be able to demonstrate knowledge and skills necessary to coordinate appeals , manage denials , and apply insurance status requirements in the acute care setting… more
- SSM Health (OK)
- …Illinois Department of Financial and Professional Regulation (IDFPR) State of Work Location: Missouri + Registered Nurse ( RN ) Issued by Compact State + Or + ... or WI)* Qualifications: 2+ years of Utilization Review experience, denials and appeals experience, and knowledge of...Registered Nurse ( RN ) - Missouri Division of Professional… more
- St. Mary's Healthcare (Amsterdam, NY)
- …of nursing required. Licensure / Certification / Registration: Required Credential(s): * Registered Nurse credentialed from the New York Board of Nursing. ... denials and audit requests and coordinates attempts to overturn denials by drafting appeals , negotiating with payers, or following up with payer utilization… more
- R1 RCM (Salt Lake City, UT)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our **Clinical Appeals Nurse ** , you will help our hospital clients by ... **Here's what you will experience working as a Clinical Appeals Nurse :** + Conduct a detailed review...at telephonic hearings if needed. **Required Skills:** + Active Registered Nurse license For this US-based position,… more
- WellSpan Health (York, PA)
- …Required + 3 years Utilization Management Experience. Preferred Licenses: + Licensed Registered Nurse Preferred Knowledge, Skills, and Abilities: + Advanced ... Responsibilities + Oversees the utilization management process for preauthorization, concurrent review, denials and appeals for System acute care facilities. +… more
- Stanford Health Care (Palo Alto, CA)
- …**This is an onsite Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN ) will be responsible for ensuring the ... to optimize patient outcomes and manage healthcare costs. 4. Denials and Appeals Management: Address and manage...systems and other healthcare software. **Licenses and Certifications** + Nursing\ RN - Registered Nurse -… more
- Ascension Health (Manhattan, KS)
- …rules and regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Kansas Board of Nursing ... related to coding, medical records/documentation, precertification, reimbursement and claim denials / appeals . + Assess and coordinate discharge planning needs… more
- Ascension Health (Tulsa, OK)
- …management rules and regulations. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Oklahoma Board of Nursing ... related to coding, medical records/documentation, precertification, reimbursement and claim denials / appeals . + Assess and coordinate discharge planning needs… more
- Brockton Hospital (Brockton, MA)
- …responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is ... external review agencies, to coordinate activities involved in medical record review, denials , appeals and reconsideration hearings. Works closely with the… more
- BrightSpring Health Services (Louisville, KY)
- …requirements + Extensive experience in working with Payer requirements, ADR requests, Denials , Appeals , RAC/ZPIC responses + Ability to prioritize tasks and ... to ensure timely processing of all episodes of care. Reviews documentation for appeals processes across the Home Health enterprise for all payor types striving to… more
- Highmark Health (Harrisburg, PA)
- …and contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials / appeals and retrospective payer audit denials . ... **Preferred** + None **EXPERIENCE** **Required** + 2 years of recent clinical RN Acute care, Home care, Palliative, Hospice, or Care Management **Preferred** +… more
- Crouse Hospital (Syracuse, NY)
- …and organization. + EDUCATION / CERTIFICATION / LICENSURE + Required: + Licensed as a Registered Nurse in New York State. + Bachelor's Degree + EXPERIENCE + ... responsible for providing day to day management of the RN Care Managers in the department. + The areas...compliance. The Manager works closely with the UM and Appeals and Denials staff as both areas… more
- Glens Falls Hospital (Glens Falls, NY)
- …Unit (BHU)! Glens Falls Hospital is seeking a strategic, forward thinking, and motivated Registered Nurse with leadership experience to join as our next Nurse ... role is for you! *Team Impact* As the Clinical Nurse Manager, you will provide overall clinical and operational...charge review . Serve as a clinical resource for appeals and denials . Review/update of Charge… more
- Ascension Health (Austin, TX)
- …management rules and regulations. **Requirements** Licensure / Certification / Registration: + Registered Nurse obtained prior to hire date or job transfer ... related to coding, medical records/documentation, precertification, reimbursement and claim denials / appeals . + Assess and coordinate discharge planning needs… more
- Ascension Health (Jacksonville, FL)
- …rules and regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse obtained prior to hire date or job transfer ... related to coding, medical records/documentation, precertification, reimbursement and claim denials / appeals . + Assess and coordinate discharge planning...date. Licensed as a Registered Nurse in Florida. Credentialed from State… more
- Stanford Health Care (Palo Alto, CA)
- …+ Master's degree in nursing (MSN) + Current unrestricted license as a Registered Nurse issued by the state of California. + National certification ... review, retrospective review of care, medical claims review, addressing denials / appeals and grievances effectively and timely, and...timely manner. **Licenses and Certifications** + ACM + CA Registered Nurse - Valid license as a… more
- Baylor Scott & White Health (Dallas, TX)
- …Benefits may vary based on position type and/or level **Job Summary** You, as a Registered Nurse in the Denial Resource Center at Baylor Scott & White Health, ... manage denials and appeals . Your job is to...relevant work experience is preferred. + Applicants should be registered nurses. Hybrid requirement: Equipment pickup, replacement, or repair.… more
- HCA Healthcare (Houston, TX)
- …appropriate. **What qualifications you will need:** + Bachelor's degree Nursing preferred + Registered Nurse - Currently licensed as a registered ... against established critical pathways. + Reviews and, if necessary, appeals Medicare/Medicaid and Managed Care denials . +...Support + Registered Social Worker (RSW), or Registered Nurse , or Certified Care Manager (CMC)… more
- Carle (Urbana, IL)
- …Location: Carle at The Fields + Weekend Requirements: no + Other Posting Information: Registered Professional Nurse ( RN ) License Illinois upon hire. + ... Outpatient Denial/ Appeals Specialist- RN + Department: Revenue...REQUIREMENTS Bachelor's Degree in Nursing CERTIFICATION & LICENSURE REQUIREMENTS Registered Professional Nurse ( RN ) License… more
- ProMedica Health System (Toledo, OH)
- …for post-acute services (ie, placements, Home Health/Home Care, DME, etc.). Escalates denials / appeals , as appropriate. 11. Follows-up with post-acute agencies to ... honor. POSITION SUMMARY The Care Navigation Resource Coordinator works directly with unit RN Acute Care Navigator(s) and Social Worker(s) and reports to the Manager… more
