- Beth Israel Lahey Health (Newburyport, MA)
- …mailing, in collaboration with other hospital departments. Organizes the follow-up appeals documentation post-audit and coordinates the submission of the Physician ... variety of sources (eg Auditors, CMS, BCBS, Permedion, DPH, Nurse Audit, HCHP, DPH, Disability, Workman's Comp, EHR, attorneys,...final review, and submission to Permedion and EHR for appeals on behalf of Case Management. Works closely with… more
- State of Colorado (Rio Grande County, CO)
- …of Employment & Appeal Rights Special Qualification: + Current & active Certified Nurse Aide license renewal required and be CPR certified, Vaccinations as required ... the position Substitutions: + Current, valid certification as a Nurse Aide (CNA) from the Colorado Department of Regulatory...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Golden, CO)
- …Education/Licensure/Certification/Experience: + Current, valid licensure as an Advanced Practice Nurse from the Colorado Board of Nursing; or current, valid ... Centers). + Current, valid licensure as an Advanced Practice Nurse from the Colorado Board of Nursing; or current,...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- HCA Healthcare (Las Vegas, NV)
- …Contact facilities, physicians' offices and/or insurance companies to resolve denials/ appeals if needed. + Demonstrates knowledge of regulatory requirements, Ethics ... + Healthcare experience in an acute care hospital. Utilization Review, appeals , denials, managed care contracting, experienced preferred. + Currently licensed as… more
- Elevance Health (Morristown, NJ)
- …will make an impact:** + Perform physician-level case review, following initial nurse review, of Medical Oncology regimens and supportive care. + Perform ... physician-level case review, following initial nurse review, of chemotherapy regimens. + Determine medical necessity...a subject matter expert. + Perform first level provider appeals as designated by the client for adverse determinations.… more
- The County of Los Angeles (Los Angeles, CA)
- …be accepted. DEFINITION: Plans, organizes, assigns, directs, and evaluates, through subordinate nurse evaluator supervisors, the work of a major section of the ... direction, through Supervising Health Facilities Evaluator, Nursing positions, to nurse evaluators responsible for surveying and investigating health care facilities… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …of administrative reviews + Performing comprehensive provider and member appeals , denial interpretation for letters, retrospective claim review, special review ... requests, and UM pre\-certifications and appeals , utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility\. + Occasional weekend… more
- State of Colorado (Denver, CO)
- …unlicensed staff member who operates under the supervision of a licensed nurse within Nursing Services. This position is generally responsible for utilizing ... staff. Assists in the creation of supervisory files for Nurse Managers and Nursing Department Leadership. Assists in the...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Denver, CO)
- …duties. This position works under the supervision and direction of a registered nurse and assists with psychiatric nursing care of mentally ill patients; observes, ... of the department's action. For more information about the appeals process, the official appeal form, and how to...do you address it? + Nothing/ tell the charge nurse or someone else. + Immediately lock the egress… more
- Mount Sinai Health System (Long Island City, NY)
- …will direct and manage departmental activities involved in utilization review, appeals management and discharge planning to facilitate the case management process ... Requirements** 5 years of Case Management and 6 years of clinical nurse experience. Previous supervisory experience in Case Management or a related field.… more