- McLaren Health Care (Port Huron, MI)
- …and participates in the resolution of retrospective reimbursement issues including appeals , PACER authorization, third party payer certification, and denied cases. ... and directed. **Qualifications:** Required ⦁ State licensure as a registered nurse (RN) ⦁ Bachelor's degree in nursing from accredited educational institution,… more
- St. Luke's Health System (Boise, ID)
- …patient-centered care. **_We are currently hiring for a Full-Time (1.0 FTE) Registered Nurse with at the Children's Endocrinology Clinic located in Boise at The ... in-basket tasks such as triaging patient concerns, handling prior authorizations, and coordinating appeals . This role offers a dynamic mix of direct patient care and… more
- Huron Consulting Group (Chicago, IL)
- …Tracking and Improvement: Provides analysis and reports of utilization, denials, and appeals KPIs, trends, patterns, and impacts to resources. Tracks, analyzes, and ... implements strategies to improve team performance based on utilization trends and identifies performance indicators, initiates monitoring process improvements. Accountable to PI performance. + Compliance and Regulatory Oversight: Demonstrates knowledge of… more
- Rush University Medical Center (Chicago, IL)
- …of each case. **Summary:** This position reviews initial clinical denials, document appeals for clinical inpatient denials, conducts appeals as appropriate. ... of experience with hospital denial or case management or nurse audit. * Knowledge of hospital revenue cycle and...posting are accurate and supported by documentation before initiating appeals process. 2. Audits claim denials to ensure coding… more
- Nuvance Health (Danbury, CT)
- …operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical support staff while partnering with local case management ... organizational efficiency, and maximized reimbursement through denial reduction and successful appeals . The *System Care Coordination Leader* will be responsible for… more
- Hartford HealthCare (Farmington, CT)
- … appeals preferred. **Licensure, Certification, Registration** * Active Registered Nurse license from the State of Connecticut * Certified Clinical Documentation ... Key responsibilities include timely investigation of DRG downgrades, submitting appeals , coordinating follow-up actions and ensuring compliance with regulatory… more
- Iowa Department of Administrative Services (State Of Iowa, IA)
- …IA Job Type Full-time Job Number 26-01561 Agency 427 Department of Inspections, Appeals & Licensing Opening Date 12/15/2025 Closing Date 3/15/2026 11:59 PM Central ... + Description + Benefits + Questions Job Description Join theDepartment of Inspections, Appeals , and Licensing's Health & Safety Divisionand play a vital role in… more
- Houston Methodist (Sugar Land, TX)
- …utilization review activities, and monitoring the clinical denial management and appeals process, as applicable, in collaboration with clinical team partners. This ... and determines the need for or feasibility of submitting appeals . + Facilitates communication with payors and external case...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
- Clark County, NV (Las Vegas, NV)
- …Pharmacy Benefits (30, 90-day retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and Dispatch Health + Retiree ... applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +...Experience" sections detailed on my application and that scoring appeals will not be allowed for this recruitment. 11… more
- State of Colorado (Pueblo, CO)
- …occurs, ambulation and feeding; + Obtains and records vital signs for review by staff nurse ; + Provide and assist with patient transfers and turning in bed; + Report ... condition and patient health care complaints to shift registered nurse ; + Empty catheter bags; offer fluids and record...of the department's action. For more information about the appeals process, the official appeal form, and how to… more