- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of ... In this role, you will be responsible for evaluating and responding to clinical and administrative denials referred to Case Management Department for appeal. You… more
- Louisiana Department of State Civil Service (Shreveport, LA)
- …the CONSAH Health Services Department, including supervision of the Health Services Nurse , to ensure student clinical credentialing, immunization compliance, and ... onboarding processes meet institutional and clinical site standards. *Maintain accurate academic and credentialing records for students in accordance with… more
- CareFirst (Baltimore, MD)
- …authorization of services and approved claims. + Prepares retrospective reviews, case appeals , billing coordination, and clinical support. + Manages the analysis ... hiring methods to meet departmental needs. We are looking for an experienced clinical leader in the greater Baltimore metropolitan area who is willing and able… more
- Alameda Health System (San Leandro, CA)
- …other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed. + Encourages patients to develop realistic plans. Makes ... care facility and/or utilization review training. Minimum Experience: Varied clinical experience or experience in case management/community health preferred.… more
- Children's Mercy Kansas City (Kansas City, MO)
- …necessity review functions utilizing InterQual and/or MCG screening guidelines, and clinical denials/ appeals oversight. Participates in department and hospital ... One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire + One...One of the following: Licensed RN - Kansas, Registered Nurse Multistate License Kansas required upon hire + RN… more
- Tufts Medicine (Melrose, MA)
- …providing clinical updates to insurance companies. 11. Coordinates insurance appeals related to discharges and adhering to policies and procedures of Medicare ... unit quality scores which meet or exceed hospital established targets for nurse sensitive quality indicators as appropriate for the unit. **About MelroseWakefield… more
- Amergis (French Camp, CA)
- …multidisciplinary teams Knowledge of current Medicare guidelines Clinical critical thinking Clinical experience x 2 years Denials nurse : We need someone that ... is current with Denials, Appeals and utilization review . If a candidate had experience with PERFORMANT or CDCR denials that would be amazing, but it is not likely… more
- Corewell Health (Royal Oak, MI)
- …criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization ... adult and Level II pediatric trauma designations. The advanced capabilities and clinical expertise within this center have earned it Magnet designation four… more
- University of Rochester (Rochester, NY)
- …Under the direct supervision of the Practice Manager, Clinic Director and Nurse Manager works with considerable latitude for independent judgement. Responsible for ... activities of peers or support staff. **ESSENTIAL FUNCTIONS** + Examines the clinical schedules(s) on a continuous basis (both weekly and daily) to identify… more
- Catholic Health Services (West Islip, NY)
- …not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and Patient Access departments to ensure ... the most advantageous clinical and financial outcomes. Supports all CH and consultant...of Science degree strongly preferred. Licensure: New York Registered Nurse (RN) License & Registration. Certification: Care Manager Certification… more