- 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)
- *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 ... This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to...* Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum of… 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...RHIA - Registered Health Information Administrator required or + CDIP -… 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
- Carle Health (Champaign, IL)
- …Information Management Association (AHIMA)American Health Information Management Association (AHIMA); Licensed Registered Professional Nurse ( RN ) - Illinois ... peers and providers we needed or requested. Reviews DRG denials and provides information to the denials ...DRG denials and provides information to the denials team related to appealing the encounter **_CDI EXPERIENCE… more
- Hartford HealthCare (Farmington, CT)
- …DRG denial management and appeals preferred. **Licensure, Certification, Registration** * Active Registered Nurse license from the State of Connecticut * ... Denial Specialist is responsible for reviewing, analyzing and appealing denials related to DRG (Diagnostic Related Group) downgrades. This role involves… 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)
- …**Weekend Requirement:** Occasional + **On Call:** No **Certifications and Licensures:** + Required RN ( Registered Nurse ) + Preferred ACM (Case Management) + ... Review or + Required 2 years in Case Management or + Required 3 years Registered Nurse + Preferred experience in Critical Care or Emergency Service **Benefits:**… 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
- 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 ... necessary in coordination with the Coding Manager and/or Coding Specialist and assist in correcting deficiencies in DRG assignment.... (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 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...Monitors activities and findings with regard to audits and denials and subsequently adjusts to potential trends when reported.… more
- McLaren Health Care (Mount Pleasant, MI)
- …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 ... other related duties as required and directed. **Qualifications:** **_Required:_** + Registered Health Information Technician (RHIT), Licensed Practical Nurse … 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 members ... 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) ... review of high-acuity patient records to identify potential and active payer denials , assess clinical validity, and to support denial prevention, analysis, and… more
- University of Southern California (Arcadia, CA)
- …coding appeals based on documentation, coding guidelines and Coding Clinic for coding denials and/or adjustments. + Extensive knowledge of Medicare Part A and how ... impact DRG assignments. + Minimum of three years' experience in clinical disciplines ( RN , MD, FMG) or utilization review/case management in an acute care facility,… more
- Henry Ford Health System (Troy, MI)
- …SUMMARY: Reporting to the Manager, Revenue Integrity, the Revenue Integrity Specialist identifies revenue opportunities and works collaboratively with Revenue Cycle ... workflows. Primary areas of focus include revenue capture accuracy, decreased denials utilizing standard optimized workflow, and reducing organization risk by… more
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible for ... information and advocating for appropriate levels of care. The UR Specialist works closely with clinical staff, admissions, medical providers, and third-party… more
- UnityPoint Health (Cedar Rapids, IA)
- …This position is on site at St. Luke's Hospital. The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments serves a key role in ... care, optimal clinical outcomes and patient and provider satisfaction. The UM Specialist provides the Utilization Management function for patients admitted to BH… more
- AnMed Health (Anderson, SC)
- …+ Initiates peer-to-peer ie MD to MD calls with payer physician to avoid denials . Qualifications + Minimum of two years of clinical experience required with current ... SC license as RN . + Bachelor of Science in nursing. + Excellent communication skills, written and verbal. + Excellent communication skills and computer experience +… more