- Mount Sinai Health System (New York, NY)
- …for appeals , On / Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in ... as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking status… more
- Houston Methodist (Sugar Land, TX)
- …management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of care for ... **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -...care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge… more
- Eastern Connecticut Health Network (Vernon, CT)
- Why consider applying to Visiting Nurse & Health Services of CT? Here are a few reasons: + Small territories and manageable caseloads and flexible schedules for a ... performs concurrent audits for compliance with state regulations and assists in progressive appeals in Medicare Claims appeals as well as documentation requests… more
- State of Colorado (Canon City, CO)
- …diagnosis, and treatment for acute, chronic, and emergency care for inmates in the clinical setting, which could include a clinic, an infirmary, or a special needs ... and other related laboratory tests; + Follow the CDOC clinical services standards and procedures, protocols, guidelines, or policies...must possess current, valid licensure as an Advanced Practice Nurse / Nurse Practitioner from the Colorado… more
- State of Colorado (Grand Junction, CO)
- …including physical, psychiatric, and dental maintenance. Primary Job Duties Clinical Management.Ensuring that health screens, health appraisals, histories and ... by formulating and implementing corrective action plans as needed. Supervises clinical staff to ensure compliance with established treatment protocols. Communication… more
- State of Colorado (Denver, CO)
- …position is responsible for, but not limited to, the following: + In a clinical setting, assist patients with activities of daily living to include bathing, mouth ... Obtains and records vital signs for review by staff nurse ; + Provide and assist with patient transfers and...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …CMS criteria * Collaborate with UM staff to draft and submit compelling clinical appeals , including summaries and supporting documentation in accordance with ... of experience in clinical care, utilization review, case management, or clinical denials/ appeals -OR- * An approved equivalent combination of education and… more
- Mount Sinai Health System (New York, NY)
- …for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission). ... with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the...companies on concurrent denial appeals e. Communicates clinical information to the payor, as needed, coordinating direct… more
- Mount Sinai Health System (New York, NY)
- …for assessment, communication and monitoring of discharge planning process (The clinical nurse initiates the discharge planning process on admission). ... with physicians and managed care companies on concurrent denial appeals 5. Communicates clinical information to the...companies on concurrent denial appeals 5. Communicates clinical information to the payor, as needed, coordinating direct… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …(UM) will manage the Utilization Management team consisting of Clinicians and Non- Clinical support staff from Intake through Appeals processing. The ideal ... candidate will have a strong clinical background within a managed care setting including a high-level understanding of prior authorization process from beginning of… more