- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks ... preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending....an accredited, professional nursing program. + Must have current RN license to practice in the state of Pennsylvania… more
- Houston Methodist (Sugar Land, TX)
- …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical… more
- Whidbey General Hospital (Coupeville, WA)
- …Centers: In the absence of, or in collaboration with, the Medical Oncology Practice Registered Nurse : + Act as a liaison, navigator and care coordinator between ... JOB SUMMARY The RN - Oncology Navigator Care Coordinator works closely...and specialty pharmacy, including obtaining prior authorizations, managing denial appeals , and facilitating re-enrollments. + Assists patients in applying… more
- State of Nevada (NV)
- …and oversee the Medical Unit in their assigned regions. The Compliance Coordinator - Registered Nurse ( RN ) position, which may be based in either ... COMPLIANCE COORDINATOR - RN APPROXIMATE ANNUAL SALARY - $73,309.68 to $109,640.88...management; OR one year of experience as a Compliance Specialist - Registered Nurse in… more
- State of Michigan (Lansing, MI)
- …Psychologist (LLP); Fully Licensed Psychologist (LP); Licensed Master Social Worker (LMSW); Registered Nurse ( RN ); Licensed Professional Counselor (LPC) + ... Departmental Specialist 13 - Specialized Nursing Home OBRA Program.... Reviews, coordinates and represents the Department on statewide appeals of preadmission screenings/annual resident reviews Medicaid recoveries before… more
- City and County of San Francisco (San Francisco, CA)
- …and Certification: + Registered Nurse License: Possession of a valid California Registered Nurse ( RN ) license issued by the California Board of ... Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a valid...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- City and County of San Francisco (San Francisco, CA)
- …and Certification: + Registered Nurse License: Possession of a valid California Registered Nurse ( RN ) license issued by the California Board of ... Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a valid...may be appealed under Civil Service Rule 110.4. Such appeals must be submitted in writing to the Department… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to… more
- Independent Health (Buffalo, NY)
- … Health Information Technician (RHIT), Certified Clinical Documentation Specialist (CCDS), American Health Information Management Association (CCS-H, CCS-P), ... growth, innovation and collaboration. **Overview** The Clinical & Coding Specialist -Senior will be responsible for reviewing coding and clinical...Certification Denials and Appeals Management (C-DAM), or NYS licensed RN … more
- UnityPoint Health (Cedar Rapids, IA)
- …40 Hours Per Week + Job ID: 168048 Overview The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments serves a key role in ... care, optimal clinical outcomes and patient and provider satisfaction. The UM Specialist provides the Utilization Management function for patients admitted to BH… more