- 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
- Corewell Health (Southfield, MI)
- …HIM and Revenue Cycle professionals in third party payer DRG audits and appeals . + Educates members of the healthcare team about clinical documentation guidelines, ... 3 years of relevant experience + State of Michigan RN License or a Physician License upon hire +...MD with CCDS or CDIP + Certified Clinical Documentation Specialist , CCDS or Documentation Improvement Practitioner About Corewell Health… 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
- 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
- State of Colorado (Denver, CO)
- …job announcement close date. MINIMUM QUALIFICATIONS: + Applicants must possess a valid, active Registered Nurse License from the State of Colorado or any state ... + Applicantsmust havefour (4) yearsof professional experience as a Registered Nurse . SUBSTITUTIONS: + Appropriate education will...of the department's action. For more information about the appeals process, the official appeal form, and how to… 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)
- …their job duties. This position works under the supervision and direction of a registered nurse and assists with psychiatric nursing care of mentally ill ... include: Provide Therapeutic Patient Care: Under the direction and supervision of a registered nurse , engage with patients to establish and maintain a… more
- Children's Mercy Kansas City (Kansas City, MO)
- …Utilization Review, and Performance Improvement Leadership + One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required ... Nurse Case Managers, Social Workers, and Utilization Review specialist team members and support staff + Analyzes, evaluates,...upon hire + One of the following: Licensed RN - Kansas, Registered Nurse … more
- State of Colorado (Sterling, CO)
- …Report changes in patient skin condition and patient health care complaints to shift registered nurse ; + Empty catheter bags; offer fluids and record Intake and ... pulse oximetry under the supervision and direction of a registered nurse ; + Maintain appropriate tool and...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Hartford HealthCare (Farmington, CT)
- …of education and experience in accordance with job responsibilities *Experience* . Minimum: . Registered Nurse ( RN ) with 5 or more years CDS experience ... (HACs), and other specialty reviews. This position also supports denials and appeals specialists as a subject matter expert (SME) and collaborates with Revenue… more