- BJC HealthCare (St. Louis, MO)
- …work experience) **Additional Information About the Role** BJC HealthCare is seeking a Clinical Appeals Specialist to assist with infusion appeals ... government and commercial plans. This individual will be handling clinical denials and sending them to a nurse...clinical denials for BJC hospitals and payors. The Clinical Appeals Specialist must be… more
- University of Washington (Seattle, WA)
- …**UW Medicine's Patient Financial Services Department** has an outstanding opportunity for a ** Clinical Appeals and Disputes Nurse .** **WORK SCHEDULE** + ... 100% FTE + 100% Remote + Days **POSITION HIGHLIGHTS** The Clinical Appeals and Disputes Nurse ensures that payers are prepared to reimburse the UW Medicine… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, ... DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code assignment and MS-DRG/APR-DRG… more
- Nuvance Health (Danbury, CT)
- *Description* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within the first 12-24 hours ... in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- Northwell Health (Melville, NY)
- …+ Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect ... retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness… 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 ... retrospective utilization management using evidenced-based medical necessity criteria; conducts clinical reviews and formulates appeal letters to support appropriateness… more
- McLaren Health Care (Mount Pleasant, MI)
- …outcomes and fulfills the obligation and responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer ... + Certified Medical Coder, Certified in Healthcare Compliance, Certified Coding Specialist , or Certified Clinical Documentation Specialist certifications more
- City and County of San Francisco (San Francisco, CA)
- … Nurse (RN) license issued by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a valid Clinical ... Candidates who have completed all requirements to obtain the Clinical Nurse Specialist Certificate may...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- State of Colorado (Pueblo, CO)
- NURSE III - Clinical Specialist ...if your application is eliminated. You will find the appeals process, the official appeal form, and how to deliver ... - Pueblo Regional Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5186234) Apply NURSE III - Clinical Specialist - Pueblo… more
- Baystate Health (Springfield, MA)
- …employees. Minimum - Midpoint - Maximum $96,137.00 - $110,510.00 - $130,728.00 **UM Regulatory Nurse Specialist - Baystate Health, Health New England** This is a ... Current States Eligible MA and CT The **UM Regulatory Nurse Specialist ** is responsible for delivering medical...license required + 3-5 years' experience as a UM Clinical Review Nurse for a Health Plan… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve ... and various health plans. Reporting to the Prior Authorization Supervisor , the Clinical Authorization Specialist is responsible for managing all work related to… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- Omaha Children's Hospital (Omaha, NE)
- …and obtains appropriate physician documentation while patients are in-house for clinical conditions and procedures to support the appropriate severity of illness, ... and complexity of care of the patient. Exhibits sufficient knowledge of clinical documentation requirements. APR-DRG assignment and clinical conditions and… more
- Houston Methodist (Sugar Land, TX)
- …management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of care for ... and billing processes, managed care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge of CPT and ICD… more
- UCLA Health (Los Angeles, CA)
- …at UCLA Health. You will become a member of our highly successful Clinical Documentation Integrity and Denial Management team, including all modalities. This role ... of high-acuity patient records to identify potential and active payer denials, assess clinical validity, and to support denial prevention, analysis, and appeals … more
- CaroMont Health (Gastonia, NC)
- …for promoting and monitoring safe, high-quality, cost-effective healthcare with the best clinical outcomes possible. Provide physician and nurse education to ... and reporting. Perform data collection and analysis, trend identification for assigned clinical outcomes, and present this data at the appropriate meetings as… more
- Fairview Health Services (St. Paul, MN)
- …the development of denial reports and other statistical reports. + Collaborates with Clinical Denials Nurse Specialist and Leadership in high-dollar claim ... **Job Overview** The Inpatient Coding Denials Specialist performs appropriate efforts to ensure receipt of...records and coding guidelines to formulate coding arguments for appeals and/or coding guidance for potential re-bills. Maintains a… more
- State of Colorado (Canon City, CO)
- DOC Nurse Supervisor - Canon City Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5180320) Apply DOC Nurse Supervisor - Canon City Salary ... - $11,717.00 Monthly Location Canon City, CO Job Type Full Time Job Number Nurse III 6253 FCF 12/2025 Department Department of Corrections Division Clinical and… more
- State of Colorado (CO)
- CDOC Registered Nurse ( Nurse I) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5123731) Apply CDOC Registered Nurse ( Nurse I) ... $10,627.00 Monthly Location Statewide, CO Job Type Full Time Job Number CAA Nurse I Statewide 10/2025 Department Department of Corrections Division Clinical and… more
- State of Colorado (Pueblo, CO)
- LICENSED PRACTICAL NURSE III - CMHHIP - Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5184282) Apply LICENSED PRACTICAL NURSE III ... Description + Benefits + Questions Department Information Licensed Practical Nurse III - Full Time CMHHIP This position will...Demonstrates understanding of the role of the Patient Right Specialist and utilizes this person as a resource when… more
Related Job Searches:
Appeals,
Appeals Nurse,
Appeals Specialist,
Clinical,
Clinical Appeals Nurse,
Clinical Appeals Specialist,
Clinical Nurse,
Nurse,
Nurse Specialist,
Specialist