- Cedars-Sinai (Beverly Hills, CA)
- …that fuels innovation. **A Little More About What You Will be Doing** The RN Care Coordinator is responsible for the case management of patient while hospitalized ... care settings. In collaboration with the Inpatient Specialty Program (ISP) hospitalists, the RN Care Coordinator will assist patients from the time they are admitted… more
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible for ... information and advocating for appropriate levels of care. The UR Specialist works closely with clinical staff, admissions, medical providers, and third-party… more
- Commonwealth Care Alliance (Boston, MA)
- …Claims Operations & Quality Assurance, the Regulatory Compliance & Audits Sr. Specialist II is responsible for ensuring CCA's operational compliance with state and ... * Translate regulatory updates into operational actions, collaborating with Claims, Appeals , UM, and Provider Services. * Conduct internal audits and retrospective… more
- Independent Health (Buffalo, NY)
- …with regulatory standards, clinical criteria, and member benefit contract. **Qualifications** + Registered Nurse ( RN ) with active, current, unrestricted NYS ... the collection and review of medical records specific to quality complaints/grievances and appeals as indicated in support of a high performing health plan and… more
- Commonwealth Care Alliance (Boston, MA)
- …issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances, and Configuration teams to validate and resolve ... record, (if applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer.… more
- The County of Los Angeles (Los Angeles, CA)
- …when needed to carry out job-related essential functions. A license to practice as a Registered Nurse issued by the California Board of Registered Nursing** ... -OR- a certificate or pocket license as a Registered Environmental Health Specialist issued by the...Certificate Section of the application is completed for the Registered Nurse License. Provide the title of… more
- State of Colorado (Denver, CO)
- …six (6) months of hire. + Applicant must have two years experience as a Registered Nurse , andsix months of gender affirming care experience, which may include, ... must possess current, valid licensure as an Advanced Practice Nurse / Nurse Practitioner from the Colorado...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Centene Corporation (Jefferson City, MO)
- …of using code editing software systems in a managed care organization preferred. **Certifications:** RN - Registered Nurse or LPN - Licensed Practical ... + Triages and resolves escalated health plan, Claims department, and provider inquires/ appeals or issues + Cross communication with IT, health plans, vendors, and… more
- McLaren Health Care (Grand Blanc, MI)
- …**_Required:_** + Associate's degree in nursing or healthcare related field **.** Current Registered Nurse license in the state of Michigan or possess a ... **4 years of utilization management, case management, clinical documentation, and/or denials/ appeals experience in an acute healthcare facility** **.** American Case… more
- Cummins Behavioral Health Systems Inc. (Avon, IN)
- …of practice (ANA). Education and/or Experience: Must possess Indiana state licensure as a Registered Nurse with certification as a Clinical Nurse ... place. * If being part of a learning organization appeals to you, get in touch with us. *...throughout central and west central Indiana. The Advanced Practice Nurse , under the supervision of a Staff Psychiatrist, will… more