- 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
- CommonSpirit Health Mountain Region (Westminster, CO)
- …provide excellent patient-centered care with teamwork and compassion. Our department appeals to anyone interested in furthering their skillset, specifically in the ... and achieve professional fulfillment united in humankindness. As a Registered Nurse (RN) you will assume responsibility and accountability for: + Facilitating,… more
- CommonSpirit Health Mountain Region (Westminster, CO)
- …pre-and post-operative care for orthopedic, abdominal, and general surgeries. 5 West appeals to anyone interested in broadening their skillset as we receive overflow ... and achieve professional fulfillment united in humankindness. As a Registered Nurse (RN) you will assume responsibility and accountability for: + Facilitating,… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …* Identifies opportunities for connecting members to group related benefits; eg Nurse Line, Employee Assistance Program, or other specialists with in BCBS Health ... of the department. * Guides member through the Prior Authorization and Appeals process. * Engage providers telephonically in reviewing and understanding treatment… more
- Sharp HealthCare (La Mesa, CA)
- …Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing **Hours** **:** **Shift Start ... acute care nursing experience or case management experience. + California Registered Nurse (RN) - CA Board of Registered Nursing **Preferred Qualifications** +… more
- Alameda Health System (San Leandro, CA)
- …other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed. + Encourages patients to develop realistic plans. Makes ... in case management/community health preferred. Preferred Licenses/Certification: Public Health Nurse , Case Management, or Home Health. Required Licenses/Certifications: BLS… more
- City and County of San Francisco (San Francisco, CA)
- …of experience as a Licensed Psychiatric Technician or a Licensed Vocational Nurse providing psychiatric nursing care in a skilled facility or psychiatric acute ... permanent or temporary (including an interim permit) California Licensed Vocational Nurse License or Licensed Psychiatric Technician License. Applicants must meet… more
- Cedars-Sinai (Beverly Hills, CA)
- …Investigates, processes and assists with the resolution of provider grievances and appeals in accordance with contractual requirements and corporate policy. + Begins ... + For patients who are transitioning to the Skilled Nursing Facilities, refers to nurse practitioner and case manager assigned to the SNF's for continued review and… more
- CareFirst (Baltimore, MD)
- …authorization of services and approved claims. + Prepares retrospective reviews, case appeals , billing coordination, and clinical support. + Manages the analysis of ... programs. **Licenses/Certifications Required Upon Hire** : Health Services\RN - Registered Nurse - State Licensure and/or Compact State Licensure. Salary Range:… more