- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the ... and denials for no authorization. The Senior Denials Management Specialist position communicates...and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS** **Required** + RN - Registered Nurse -… 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
- Community Health Systems (Franklin, TN)
- …+ CRNP, LPN, RN , MD, PA, or DO preferred + CCS-Certified Coding Specialist required or + RHIT - Registered Health Information Technician required or + ... **Job Summary** The DRG Denials Auditor conducts hospital inpatient DRG denial audits...Medical Coding Program preferred + Associate Degree Health Information Management or related field preferred + 3-5 years Inpatient… more
- St. Luke's University Health Network (Allentown, PA)
- …Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. . ... a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews...and procedure code assignment and MS-DRG/APR-DRG accuracy based on denials or audit findings from government and commercial payers.… more
- Hartford HealthCare (Farmington, CT)
- … management and appeals preferred. **Licensure, Certification, Registration** * Active Registered Nurse license from the State of Connecticut * Certified ... Denial Specialist is responsible for reviewing, analyzing and appealing denials related to DRG (Diagnostic Related Group) downgrades. This role involves… more
- Carle Health (Champaign, IL)
- … Association (AHIMA)American Health Information Management Association (AHIMA); Licensed Registered Professional Nurse ( RN ) - Illinois Department of ... nurses, ancillary staff, and the coders in Health Information Management to identify and record principal and secondary diagnoses,...peers and providers we needed or requested. Reviews DRG denials and provides information to the denials … more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Prior Authorization experience is preferred. Certification/Licensure/Registration: Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. ... molecular pathology, high-cost drug, and off-label drug authorizations. The Clinical Authorization Specialist is also responsible for managing denials related to… more
- BayCare Health System (Tampa, FL)
- …Call:** No **Certifications and Licensures:** + Required RN ( Registered Nurse ) + Preferred ACM (Case Management ) + Preferred CCM (Case Manager) ... or + Required 2 years in Case Management or + Required 3 years Registered Nurse + Preferred experience in Critical Care or Emergency Service **Benefits:** +… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to… more
- UPMC (Pittsburgh, PA)
- … Health Information Administrator OR Registered Health Information Technician (RHIT) OR Registered Nurse ( RN ) + Act 34 *Current licensure either in ... to coding and compliance guidelines. + Meet with coding management as scheduled to review progress, discuss problems, and... (CCS) OR Certified Professional Coder (CPC) OR Certified Registered Nurse Practitioner OR Doctor of Medicine… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Clinical Documentation Integrity Specialist , Clinical Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the ... to be named a Forbes "Best Employer" seven times. Position Summary: The CDI Specialist serves as a liaison between the physicians and hospital departments to promote… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Clinical Documentation Integrity Specialist Certified Clinical Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is ... Forbes as a Best Employer. Position Summary: The CDI Specialist serves as a liaison between the physicians and...assign initial DRGs and GLMOS for physician and case management to follow. + Collaborates extensively with individual physicians… 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
- St. Peters Health (Helena, MT)
- The Utilization Management RN reports directly to Utilization Review RN Coordinator. The UR RN supports the UR RN Coordinator and other UR team ... peer calls for both hospital admissions and for specific outpatient service denials as assigned, and participation in the organizations Utilization Review Committee.… more
- UCLA Health (Los Angeles, CA)
- …self-directed individual with: * Bachelor's degree in health-related field, preferred * A Registered Nurse ( RN ) license or MD diploma (or equivalent) ... a member of our highly successful Clinical Documentation Integrity and Denial Management team, including all modalities. This role involves daily review of… more
- University of Southern California (Arcadia, CA)
- …impact DRG assignments. + Minimum of three years' experience in clinical disciplines ( RN , MD, FMG) or utilization review/case management in an acute care ... (Required) + Graduate from a program of nursing, BSN, Health Information Management RHIT, RHIA, or foreign medical doctorate degree strongly preferred. + Accredited… more
- AnMed Health (Anderson, SC)
- …position is responsible for performing the daily operations of the Utilization Management program at AnMed within the Care Coordination model. These duties include ... necessity review, continued stay/concurrent review, retrospective review, bed status management , resource utilization management , regulatory compliance, and… more
- Henry Ford Health System (Troy, MI)
- …involving all appropriate personnel. Prepares reports and recommendations for management and coordinates implementation. The Revenue Integrity Specialist ... SUMMARY: Reporting to the Manager, Revenue Integrity, the Revenue Integrity Specialist identifies revenue opportunities and works collaboratively with Revenue Cycle… more
- BriteLife Recovery (Englewood, NJ)
- …+ Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in denials , approvals, and ... What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team...of 2-3 years of experience in utilization review, case management , or insurance coordination in a behavioral health or… more
- UnityPoint Health (Cedar Rapids, IA)
- …Overview This position is on site at St. Luke's Hospital. The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments serves a ... clinical outcomes and patient and provider satisfaction. The UM Specialist provides the Utilization Management function for...to quality care, effective utilization of resources and pursues denials of payment and referrals in a timely, legible… more
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