- Corewell Health (Dearborn, MI)
- …when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization for care and ... care management, utilization review, home care and/or discharge planning. Preferred + Registered Nurse (RN) - State of Michigan Upon Hire required + Basic Life… more
- System One (Las Vegas, NV)
- …notify care management team of LTSS approvals and denials, and support the appeals process as needed + Collaborate with Care Managers and/or providers to collect ... and standards of care Licensure and Certification: + Current, unrestricted Registered Nurse (RN), Licensed Social Worker (LSW), or Licensed Independent Social Worker… more
- BrightSpring Health Services (Bowling Green, KY)
- …issues. Refer all unresolved issues to the next level including grievance and appeals . + Actively market plan to new senior care partners within plan Service ... needs and provide preventive, coordinated, and quality healthcare. With a dedicated nurse practitioner leading a personalized care plan, we strive to improve the… more
- CaroMont Health (Gastonia, NC)
- …healthcare with the best clinical outcomes possible. Provide physician and nurse education to achieve compliance with best practice and evidence-based guidelines. ... departments and committees. Assist with retrospective reviews and preparation of appeals as indicated. Facilitate peer review activities and integrate review… more
- Brockton Hospital (Brockton, MA)
- …agencies, to coordinate activities involved in medical record review, denials, appeals and reconsideration hearings. Works closely with the physician advisor to ... EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is reasonable to… more
- Community Health Systems (Franklin, TN)
- …role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate efficient ... and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required + CCM -… more
- NHS Management, LLC (Tuscaloosa, AL)
- …with the assessment and the plan of care. QUALIFICATIONS + Must be a Registered Nurse in good standing in the state(s) in which assigned + Must be knowledgeable in ... of Medicare and Rehabilitation in gathering information for Medicare and Medicaid appeals and denials as requested. + During facility visits, conducts an exit… more
- San Antonio Behavioral Health (San Antonio, TX)
- …staff as needed. Essential Duties: + Collaborate and set standards with registered nurse (RN) case managers (CMs) and outcome managers to ensure that all ... of potential denials and respond appropriately; ie facilitate Physician to Physician appeals when appropriate and assist with construction of appeal letters. +… more
- Johns Hopkins University (Baltimore, MD)
- …to patient questions and concerns that a Medical Office Coordinator or nurse cannot answer + Refills urgent prescriptions and/or tracks current prescriptions for ... receiving ongoing care. + Assist with medication prior authorizations and appeals . + Assist Medical Office Coordinators with procedure pre-authorizations as needed.… more
- 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