- BronxCare Health System (Bronx, NY)
- …arrive in letter and electronic format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal ... Overview The Appeals Manager is responsible to assist in the...for timely response by the department physician advisors and clinical staff. Qualifications - NYS Registered Nurse … more
- Nuvance Health (Danbury, CT)
- *Description* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within the first 12-24 hours ... in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with...notice of conversion, etc. * Tracking and trending all appeals and communicating on a daily/regular basis with the… more
- LA Care Health Plan (Los Angeles, CA)
- …in Nursing for Registered Nurses Experience Required: At least 8 years of clinical appeals and grievances experience in a managed care, utilization management ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017… more
- McLaren Health Care (Mount Pleasant, MI)
- …outcomes and fulfills the obligation and responsibilities of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer ... . Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews… more
- Dignity Health (Rancho Cordova, CA)
- …and maintaining patient confidentiality (HIPAA) are also essential. Ultimately, the Appeals and Grievances Nurse monitors denial trends, recommends corrective ... **Job Summary and Responsibilities** The Appeals and Grievances LVN is a critical role...entities. This individual acts as a primary liaison for clinical denials, navigating appeal processes through all delegated levels.… more
- Cognizant (Salem, OR)
- …cycle or clinic operations + Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews + ... have to be considered** + Educational background - Registered Nurse (RN) + 2-3 years combined clinical ...stand out** + Epic experience + Experience in drafting appeals disputing inpatient clinical validations audits is… more
- HCA Healthcare (Salem, VA)
- …**Introduction** Do you want to join an organization that invests in you as a Clinical Nurse Reviewer? At Parallon, you come first. HCA Healthcare has committed ... make a difference. We are looking for a dedicated Clinical Nurse Reviewer like you to be...+ A minimum of one-year experience with denials and appeals in a clinical setting preferred +… more
- UNC Health Care (Kinston, NC)
- … denials for validity and probability to overturn, proactively gathers required clinical documentation and formulates appropriate appeals . Coordinates with the ... Advisors and subject matter experts for all audit and appeals work activities. Assists with documentation review to support...preferred. + **EXPERIENCE** + Minimum 3-5 years of applied clinical experience as a Registered Nurse required.… more
- Integra Partners (Troy, MI)
- …of UM authorization reviews, both verbally and in writing + Process administrative and clinical appeals and refer as needed to the Medical Director + Maintain ... care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key role in collaborating… more
- State of Colorado (Denver, CO)
- Registered Nurse , Health Compliance Inspector Home Care - FAA00601 (HP III RN) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5183355) Apply ... Registered Nurse , Health Compliance Inspector Home Care - FAA00601 (HP...(RN) Health Professional III , you will use your clinical expertise to ensure quality of care, protect patient… more
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