- Calvary Hospital (Bronx, NY)
- …to facilitate reimbursement for services provided by the Hospital. Oversees the appeals process for those cases for which reimbursement has been denied. Conducts ... QUALIFICATIONS: 1. Master of Nursing Degree required. 2. NYS unencumbered Registered Nurse License required. 3. Ten (10) to fifteen (15) years of management… more
- Corewell Health (Grand Rapids, MI)
- …review of previous clinical decisions by Priority Health Medical Directors ( appeals ). There will be opportunities to clinically contribute to discussions specific ... participate in support of medical management + Provide clinical oversight to nurse case management and utilization management. + Promote and advocate for… more
- Corewell Health (Royal Oak, MI)
- …when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization for care and ... management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan License Upon Hire required How Corewell… more
- Garnet Health (Middletown, NY)
- …the day to day operation of the CDI department and DRG Denials appeals process. The Manager will develop, implement and evaluate processes, policies and procedures ... within 6 months * Current license to practice as a Registered Professional Nurse in New York State required. Physical Requirements: Travel to multiple facilities is… more
- Houston Methodist (Houston, TX)
- …analytics and real-time dashboards to proactively manage authorization workflows, appeals , and peer reviews. **GROWTH/INNOVATION ESSENTIAL FUNCTIONS** + Identifies, ... programs preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure - Must obtain permanent… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …collaboration/supervision agreements with Advance Practice Professionals (Certified Registered Nurse Practitioners or Physician Assistants) and provide ongoing ... including but not limited to development of standards, insurance company appeals and teleconferences and provision of prior authorization information; +… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …collaboration/supervision agreements with Advance Practice Professionals (Certified Registered Nurse Practitioners or Physician Assistants) and provide ongoing ... including but not limited to development of standards, insurance company appeals and teleconferences and provision of prior authorization information; e.… more