- Sharp HealthCare (San Diego, CA)
- …Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing; Accredited Case Manager (ACM) ... experience or equivalent experience in the healthcare setting. + California Registered Nurse (RN) - CA Board of Registered Nursing **Preferred Qualifications** +… more
- AdventHealth (Orlando, FL)
- …nursing theory and practice to give and evaluate patient care. The Registered Nurse (RN) is responsible for providing and supervising direct and indirect total ... of medical necessity etc. + Complete prior authorizations for medications, appeals /peer to peers/letters of medical necessity + Assist benefits team in… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …all Clinical Services (CS) functions (prior authorization, concurrent review, appeals , case management, disease management, population health) per defined Client ... all WC State Reporting and audits. Essential Qualifications + Currently licensed Registered Nurse (RN), Nurse Practitioner (NP), or Physician Assistant (PA) with… more
- Elderwood (Cheektowaga, NY)
- Salary $38 - $49.50 per hour Overview Are you a Registered Nurse (RN) with Medicare experience? Do you consider yourself an expert in assessment and reimbursement ... for pre and post-pay record reviews, ADR requests and appeals processes. + Manages NYS RUGs III case mix...RN - MDS Coordinator - Qualifications: + Licensed Professional Nurse (RN licensure preferred) with current license in state… more
- Bassett Healthcare (Cooperstown, NY)
- …and financial indicators including LOS, excess days, resource utilization, denials and appeals , swing bed statistics. + Uses data to drive decisions and ... Licensure/Certifications: + Current NYS licensure as a Registered Professional Nurse , if applying as a nurse , required...Registered Professional Nurse , if applying as a nurse , required + Case Management certification, preferred + Case… more
- Fallon Health (Worcester, MA)
- …authorization information in QNXT because of determinations made by Authorization Coordinators, Nurse Reviewers and/or Nurse Care Specialists. + Handles an ... contract information, benefits, etc.), including authorization details when requested for appeals . + Distributes departmental facsimiles; checks Right Fax no less… more
- Centene Corporation (Jefferson City, MO)
- …+ Triages and resolves escalated health plan, Claims department, and provider inquires/ appeals or issues + Cross communication with IT, health plans, vendors, and ... a managed care organization preferred. **Certifications:** RN - Registered Nurse or LPN - Licensed Practical Nurse ...Registered Nurse or LPN - Licensed Practical Nurse - State Licensure and/or Compact State Licensure preferred… more
- Rochester Regional Health (Rochester, NY)
- …hospital and payors, ensuring accurate communication of clinical information, supporting appeals , and optimizing benefit use. + Collaborates with care teams to ... care experience + Licensed in New York State as a Registered Nurse PREFERRED QUALIFICATIONS: + Case Management or Utilization Management experience + Bachelor's… more
- Children's Mercy Kansas City (Kansas City, MO)
- …utilizing InterQual and/or MCG screening guidelines, and clinical denials/ appeals oversight. Participates in department and hospital performance improvement ... One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire + One...One of the following: Licensed RN - Kansas, Registered Nurse Multistate License Kansas required upon hire + RN… more
- Highmark Health (Pittsburgh, PA)
- **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care and manages ... contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials/ appeals and retrospective payer audit denials. Collaboratively formulates plans… more