- University of Utah Health (Salt Lake City, UT)
- …continued stay review. + Communication to third-party payers for initial and concurrent clinical review. + Reviews patient chart to ensure patient continues to meet ... LOS, expected cost, or over/under-utilization of resources. + Performs verbal/fax clinical review with payer as determined by nursing judgment and/or collaboration… more
- Sanford Health (Rapid City, SD)
- …conditions. Additionally includes admission certification, continued stay authorization, clinical documentation improvement, and interaction with payers. Additional ... duties include management of medical denials, appeals , and grievances. Understand and provide insight into evaluating...for Nursing Education Accreditation (NLN CNEA). Four years of clinical nursing experience required. Two years experience as a… more
- McLaren Health Care (Port Huron, MI)
- …(inpatient vs. outpatient) based on medical necessity. Actively seeks additional clinical documentation from the physician to optimize hospital reimbursement when ... requirement. 5. Documents in the electronic medical record (EMR): clinical reviews (medical necessity), payer authorizations, avoidable days, readmission risks,… more
- Amaze Health (Denver, CO)
- …healthcare in America, one patient at a time. We're seeking a patient-focused Nurse Practitioner (NP) or Physician Assistant (PA) to join our growing team. In ... identify the root cause of symptoms and health concerns. + Integrate clinical expertise, patient history, and diagnostics to make sound, evidence-based decisions. +… more
- International Medical Group (Indianapolis, IN)
- …outpatient management of assistance cases. + Knowledge of the Non-certification process and Appeals process including logs and time frames. + Participate in the on ... and/or seminars. + Support and participate in Quality Management activities. + Utilize clinical support tools as indicated. + Maintain a working knowledge of the any… more
- Crouse Hospital (Syracuse, NY)
- …department, including Utilization Management, Discharge Planning and Denials and Appeals functions. + Assessing workflow related to readmission prevention, length ... Care Coordination Manager Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree +...care setting or other care continuum experience in a clinical setting + Knowledge of regulatory requirements related to… more
- Huron Consulting Group (Chicago, IL)
- …Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new ... partnerships, clinical services and technology is not enough to create...Improvement: Provides analysis and reports of utilization, denials, and appeals KPIs, trends, patterns, and impacts to resources. Tracks,… more
- Select Medical (Harrisburg, PA)
- **Overview** **Hospital Name: Central PA Neuro Transitional Center** **Position:** ** Clinical Liaison (RN, OT, PT, or SLP)** **Location: Harrisburg, PA** **Schedule: ... Full-time, M-F 8am - 5pm** ** Clinical Liaison (RN, OT, PT, or SLP)** **Competitive base...Obtaining insurance approvals and authorizations, as well as facilitating appeals for patients + Demonstrates positive referrer satisfaction and… more
- Nuvance Health (Danbury, CT)
- …and operational oversight for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while partnering with local case ... specialists to meticulously investigate denied claims, prepare comprehensive appeals , and collaborate with clinical staff to...nurse (RN) * Minimum of 5 years of clinical experience in an acute care setting * Minimum… more
- Rush University Medical Center (Chicago, IL)
- …the Care Management Department and Rush University Medical Center. 11. Coordinates clinical appeals process and participates in in compliance investigations as ... circumstances of each case. **Summary:** This position reviews initial clinical denials, document appeals for clinical...of experience with hospital denial or case management or nurse audit. * Knowledge of hospital revenue cycle and… more