- Sharp HealthCare (San Diego, CA)
- …1 **Shift Start Time** **Shift End Time** Other; California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians **Hours** ... care. **Required Qualifications** + Other : Graduate of an accredited Licensed Vocational Nurse (LVN) program. + California Licensed Vocational Nurse (LVN) - CA… more
- Alameda Health System (Oakland, CA)
- …of quality improvement initiatives. + Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals . ... post-acute and psych; three years of InterQual and/or MCG. Strong clinical nursing background. Required Licenses/Certifications: Valid license to practice as a… more
- State of Colorado (Pueblo, CO)
- …medications and treatments; documents refusals of medications and reports this to the clinical team; and all information relevant to all aspects of the clients' ... pain or other medical needs to the Provider or Nurse + Knowing the 10 rights of Medication Administration,...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Denver, CO)
- …the work assigned to this position. and current, valid licensure as a Registered Nurse from the Colorado Board of Nursing or any state participating in the Enhanced ... Nurse Licensure Compact (eNLC). OR Education and Experience: A...the successful candidate. + Knowledge of Acute Care Facility Clinical operations such as hospitals, ambulatory surgery centers, and… more
- Centene Corporation (Jefferson City, MO)
- …the auditing of corporate, health plan, and specialty company staff related to clinical systems entry and/or processes + Develop and maintain the audit process and ... tools related to: authorizations, appeals , quality events, and case management in CCMS; interrater...auditing outcomes and system maintenance with the Sr. + Clinical Systems Specialist to resolve or enhance clinical… more
- Guthrie (Binghamton, NY)
- …in basket monitoring, overdue results, referrals, provider orders and support the nurse navigator role. Experience: A minimum of 2 years' experience preferred in ... state in which the position resides. Licenses: Licensed Practical Nurse in the state of position. Essential Functions: Patient...of coverage of ordered medications. + Coordinate and complete appeals for denials as needed + Monitor and Review… more
- Molina Healthcare (Tacoma, WA)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of high ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides support for … more
- Sharp HealthCare (San Diego, CA)
- …Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing **Hours** **:** **Shift Start ... care areas. This position requires the ability to combine clinical /quality considerations with regulatory/financial/utilization review demands to assure patients are… more
- Highland Hospital (Rochester, NY)
- … clinical documentation, forms/paperwork requested by patients, prior authorization appeals , sign home care orders + Coordinate with other providers, home ... sessions may be done from home via telemedicine dependent on clinical availability, personal preference, and insurance guidelines for telemedicine coverage… more
- Texas Health Resources (Arlington, TX)
- …the following: Compliance with program expectations Mitigation activities with all clinical partners / payors as needed. Compliance requirements: Code 44 ... days, etc. Medical necessity criteria, patient status, and discharge criteria. All clinical and transition documentation Clinical Review staff requirements and… more