- Beth Israel Lahey Health (Plymouth, MA)
- …multidisciplinary team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor ... establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate efficient… 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). ... **Job Description** **RN/Case Manager MSH Case Management PT Days** The Case...with physicians and managed care companies on concurrent denial appeals e. Communicates clinical information to the… more
- Mount Sinai Health System (New York, NY)
- …as per department protocol (IPRO Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status of denials + Tracking ... for appeals , On / Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in… more
- Sharp HealthCare (San Diego, CA)
- …**Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** California Registered Nurse (RN) - CA Board of Registered Nursing; Bachelor's Degree in Nursing; ... Certified Case Manager (CCM) - Commission for Case Manager ...care areas. This position requires the ability to combine clinical /quality considerations with regulatory/financial/utilization review demands to assure patients… more
- Bassett Healthcare (Cooperstown, NY)
- …and enjoy the best quality of life possible. What you'll do The Case Manager RN supports the physician and interdisciplinary team in facilitating patient care, with ... the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate… more
- Highmark Health (Pittsburgh, PA)
- …and contractual requirements. + Documents, monitors, intervenes/resolves and reports clinical denials/ appeals and retrospective payer audit denials. ... Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care...lieu of a degree + 3 years in a clinical nursing role + Current State of PA RN… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Blue Cross and Blue Shield of Minnesota Position Title: Care Advocacy Case Manager RN Location: Remote Career Area: Health Services About Blue Cross and Blue ... needs across the continuum of care by leveraging member partnership, pre-service clinical utilization review, case and disease management processes, skill sets and… more
- Eastern Connecticut Health Network (Manchester, CT)
- POSITION SUMMARY: The Care Manager provides a link between provider and payer organizations, physicians and the community in the transition of patient care through ... with the interdisciplinary team. Communicates, as appropriate, the patient's clinical condition and care needs. Demonstrates knowledge of the principles… 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: American Case Management, Certified Case Manager required upon hire + Employees must obtain American… more