- Rush University Medical Center (Chicago, IL)
- …origin, disability, veteran status, and other legally protected characteristics. **Position** Appeal Specialist RN **Location** US:IL:Chicago **Req ID** ... more
- St. Luke's University Health Network (Allentown, PA)
- …near vision, visual monotony. EDUCATION: Graduate of an accredited professional nursing program. Registered nurse with current license to practice in the state ... more
- HonorHealth (Scottsdale, AZ)
- …of communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors ... 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 ... more
- Ochsner Health (New Orleans, LA)
- …in Appeal /Denial Management **Certifications** Required - Current State of Louisiana Registered Nurse ( RN ) License Preferred - Certification in Case ... more
- Baptist Memorial (Memphis, TN)
- …prior to initial appeal action in order to optimize reimbursement and utilization of resources. + Prepares response to appeal /request for information based ... more
- Healthfirst (IA)
- …Termination, and Suspension of services. The end to end process requires the Specialist to independently: + Research issues + Reference and understand HFs internal ... more
- Ascension Health (Baltimore, MD)
- …process. + Serve as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. + ... more
- CaroMont Health (Gastonia, NC)
- …conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. Where warranted, the Appeals Specialist will write ... more
- Ascension Health (Baltimore, MD)
- …and salary range at the time of the offer._ **Responsibilities** Manage assigned Registered Nurse ( RN ) case managers, related activities and workflow ... more
- Molina Healthcare (Columbus, OH)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of previously denied ... more
- Hospice of Michigan (Kalamazoo, MI)
- …CARE Model of Service: courtesy, acknowledgement, response and empathy. Qualifications: + Registered Nurse with a baccalaureate degree in nursing, preferably a ... more
- VNS Health (Manhattan, NY)
- …to State Fair Hearings. Attends Fair Hearings in person with the Grievance and Appeals' RN Specialist and presents arguments in defense of the appeals. + Works ... more
- WMCHealth (Valhalla, NY)
- …ensuring all denials are captured & appealed in a timely manner. Coordinating appeal discussions with clinical & third party payors. + Develop, Implement and ... more