- Crouse Hospital (Syracuse, NY)
- …department, including Utilization Management, Discharge Planning and Denials and Appeals functions. + Assessing workflow related to readmission prevention, length ... of stay and daily review of observation admissions. + Works with Business Office...Care Coordination Manager Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree +… more
- Nuvance Health (Danbury, CT)
- …oversight for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while partnering with local case management ... will be responsible for leading a team encompassing utilization review and denials/ appeals specialists and will need...nurse (RN) * Minimum of 5 years of clinical experience in an acute care setting * Minimum… more
- Hartford HealthCare (Farmington, CT)
- …Responsibilities:_** **Key Areas of Responsibility** *Denial Resolution* . Conduct a thorough review of medical records, coding and clinical documentation to ... . Prepare, document and submit appeals for DRG denials, ensuring appeals are well-supported with clinical evidence, coding guidelines, and regulatory… more
- Omaha Children's Hospital (Omaha, NE)
- …opportunities for improvement. Assists with preparation and presentation of clinical documentation monitoring/trending reports for review with physicians ... and obtains appropriate physician documentation while patients are in-house for clinical conditions and procedures to support the appropriate severity of illness,… more
- CaroMont Health (Gastonia, NC)
- …for promoting and monitoring safe, high-quality, cost-effective healthcare with the best clinical outcomes possible. Provide physician and nurse education to ... staff departments and committees. Assist with retrospective reviews and preparation of appeals as indicated. Facilitate peer review activities and integrate … more
- Molina Healthcare (Tacoma, WA)
- …(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 this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...for clinical member services review assessment processes. Responsible… more
- State of Colorado (Denver, CO)
- …hormone treatment, receiving referrals for gender affirming procedures. + Facilitate review of gender affirming treatment referrals by the Gender Dysphoria Treatment ... in other committees as assigned. + Perform offender health record reviews; + Review laboratory, x-ray and EKG results and intervene as medically indicated; + Perform… more
- Children's Mercy Kansas City (Kansas City, MO)
- …review functions utilizing InterQual and/or MCG screening guidelines, and clinical denials/ appeals oversight. Participates in department and hospital ... training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient statusing… more
- Elevance Health (Miami, FL)
- …members and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens ... ** Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical...and supportive care. + Perform physician-level case review , following initial nurse review ,… more
- State of Colorado (Pueblo, CO)
- …increase and support treatment programming in all CMHHP patient units by managing clinical staff call-offs and deployment in order to minimize clinical treatment ... cancellations. The goal of the department is to maintain clinical staffing levels which will assist with patient stabilization,...+ Reports abuse allegations right away to the charge nurse and immediate supervisor, and refers to public safety.… more