- Nuvance Health (Danbury, CT)
- …or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience in an acute care setting * ... and operational oversight for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while partnering with local case… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating...conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate… more
- Veterans Affairs, Veterans Health Administration (Eagan, MN)
- …at the right time. Responsibilities **These positions may be filled by a Registered Nurse , Physical Therapist, or Occupational Therapist. These positions are ... program eligibility, service delivery, location, level of care discharge planning, appeals process, and performance improvement. Conducts comprehensive clinical … more
- Veterans Affairs, Veterans Health Administration (Eagan, MN)
- …at the right time. Responsibilities **These positions may be filled by a Registered Nurse , Physical Therapist, or Occupational Therapist. These positions are ... program eligibility, service delivery, location, level of care discharge planning, appeals process, and performance improvement. Conducts comprehensive clinical … more
- Excellus BlueCross BlueShield (Rochester, NY)
- …the use of medical and health care services for members. The SN CHA Nurse may also perform other technical and administrative tasks essential to the efficient ... expert and occasionally works directly with the operation and clinical staff to resolve issues and escalated problems. +...other functions as assigned by management. Minimum Qualifications: + RN with valid and current NYS Nursing Licensure. +… more
- State of Colorado (Pueblo, CO)
- …this position include: Clinical Skills: + Under the supervision of a registered nurse , interact with patients to build and sustain a therapeutic relationship ... position works under the supervision and direction of a registered nurse and assists with psychiatric and...should be reported by alerting public safety, the charge RN , the Lead Nurse , and the nursing… more
- Houston Methodist (Sugar Land, TX)
- …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or...care contracts and coordination of benefits related to coverage, clinical appeals , and denials to include knowledge… more
- Beth Israel Lahey Health (Plymouth, MA)
- …establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical ... team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding… more
- State of Colorado (Pueblo, CO)
- …exists to deliver nursing care and therapeutic interventions under the supervision of a registered nurse . The Client Care Aide II provides nursing care as ... any claims of any type of harassment/work place violence, alerts public safety/charge RN /Lead Nurse /and nursing appointing authority. + Arrives to work on time… more
- Sharp HealthCare (San Diego, CA)
- …**Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... or equivalent experience in the healthcare setting. + California Registered Nurse ( RN ) - CA...will participate in venues to reduce barriers to discharge.The RN CM I Collaborates with Clinical Resource… more