- Rady Children's Hospital San Diego (San Diego, CA)
- … management process for acute inpatients. Case Managers perform concurrent review and denials management based on acute care guidelines with a focus on ... of care. MINIMUM QUALIFICATIONS: BLS for Health Providers (American Heart Association) California RN License Bachelor's Degree in Nursing 4 years nursing in an acute… more
- Stony Brook University (Stony Brook, NY)
- …communication skills while adhering to our high standard of excellence. **Duties of a RN Case Manager in the Care Management Department may include the following ... assigned. Identifies, follows and documents Avoidable delays in Care Management Program. Reviews and documents on patients who were...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …knowledge of different claim types is desired. (Preferred) + Current Washington State License: Registered Nurse ( RN ), Advanced Registered Nurse ... procedure and diagnosis codes, and support business decisions regarding utilization management activities and guidelines. + Support medical policy development and… more
- Houston Methodist (Sugar Land, TX)
- …of care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS** **Required** + RN - Registered Nurse - Texas State Licensure - ... At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical… more
- Nuvance Health (Danbury, CT)
- …and trending all appeals and communicating on a daily/regular basis with the Denials Management team. * Assists with informing Managed Care contracting team ... This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to...required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting… more
- Houston Methodist (Katy, TX)
- …with nationally recognized medical necessity review guidelines **LICENSES AND CERTIFICATIONS** **Required** + RN - Registered Nurse - Texas State Licensure - ... leaders on medical necessity and level-of-care criteria. + Oversees the denials management clinical team for concurrent, retrospective, and self-denial… more
- Nuvance Health (Danbury, CT)
- …in nursing, health administration, or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience ... and strategy for system-wide care coordination, encompassing utilization review (UR), denials management , discharge planning, social work, and non-clinical… more
- Crouse Hospital (Syracuse, NY)
- … of the RN Care Managers in the department, including Utilization Management , Discharge Planning and Denials and Appeals functions. + Assessing workflow ... Office staff regarding workflow processes and maintains an effective denials management process. + General operational oversight...agreements. Care Coordination Manager Requirements: + Licensed as a Registered Nurse in New York State +… more
- Houston Methodist (Katy, TX)
- …leading multi-site or enterprise-level programs preferred **LICENSES AND CERTIFICATIONS** **Required** + RN - Registered Nurse - Texas State Licensure ... exposure to confidential/sensitive information + Proven expertise in throughput optimization, denials management , and team leadership across diverse care… more
- HealthTrust Workforce Solutions (San Antonio, TX)
- …access to more than 200,000 jobs nationwide. **_JOB SUMMARY_** The Interim Leader of Case Management Services is a Registered Nurse who participates as an ... and resource management , cost control, contract compliance, quality improvement, utilization management , denials management and management of… more
- Carle Health (Champaign, IL)
- …with or by the authorization of the Chief Medical Officer and works with our Utilization Management RN team, Clinical Denials Management team and the ... and ad hoc meetings related to utilization management , case management and clinical denials management . + The Behavioral Health Physician Advisor is also… more
- CenterWell (Denver, CO)
- …a part of our caring community and help us put health first** The Director Denials Management provides leadership for the audit, appeal and review process to ... the highest level of clinical and regulatory integrity and compliance. Manages the Denials Management data analytics, denial and appeal process. The Director,… more
- McLaren Health Care (Mount Pleasant, MI)
- …and Responsibilities as Assigned:** 1. Supports activities consistent with Integrated Care Management Denials across all MHC subsidiaries. 2. Accountable for ... 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… more
- University of Washington (Seattle, WA)
- …changes impacting revenue cycle **REQUIREMENTS** + Active licensure to practice as a Registered Nurse in Washington State + Bachelor's degree in Nursing + ... an outstanding opportunity for a **Clinical Appeals and Disputes Nurse .** **WORK SCHEDULE** + 100% FTE + 100% Remote...required in one of the following areas: clinical, case management , denials , billing + Familiarity with National… more
- Houston Methodist (The Woodlands, TX)
- …with HM performance that demonstrates leadership responsibility **LICENSES AND CERTIFICATIONS** **Required** + RN - Registered Nurse - Texas State Licensure ... At Houston Methodist, the Director Case Management & Social Services RN position...of opportunities for appropriate utilization of resources to avoid denials and resource management as it pertains… more
- Geisinger (Scranton, PA)
- …theft protection, universal life and pet and legal insurance Position Details The Registered Nurse Care Manager works with physician and multidisciplinary team ... Experience Minimum of 3 years-Nursing (Required) Certification(s) and License(s) Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania OUR PURPOSE… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse ( RN ) - Case Manager - 2506003285 Description : Join our dedicated healthcare team where compassion meets innovation! As a Registered ... and is determined by employment status Job Description: The RN Case Manager is responsible to facilitate care along... experience preferred. 3. License to practice as a Registered Nurse in the State of Michigan.… more
- Cedars-Sinai (Los Angeles, CA)
- …of Essential Duties: + The Utilization Management (UM) Registered Nurse - Medicare Short Stay & Concurrent Denials supports post-discharge clinical ... for Medicare Short Stay cases and assists with real-time management of concurrent payer denials . + This...Eye/Hand/Foot Coordination **Req ID** : 14355 **Working Title** : Registered Nurse -Utilization Review Case Manager -… more
- Baystate Health (Springfield, MA)
- …Diem Hospital Case Manager** The ** RN Hospital Case Manager** is a registered nurse responsible for the coordination of clinical care, quality, and financial ... interventions for patients at risk for readmissions + Manages concurrent denials and works with physicians to overturn for appropriate reimbursement **Required… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits for both RAC and non-RAC accounts, reviewing patient records for accuracy in ... the denial and appeal status. + Consults with Coordinator and/or Director, Coding Denials and Appeals during any audit discrepancies. + Attends coding education to… more
