- City and County of San Francisco (San Francisco, CA)
- …( RN ) license issued by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a valid Clinical ... designing and implementing plans for meeting such needs. The Clinical Nurse Specialist performs other...as assigned/required. Minimum Qualifications + License and Certification: + Registered Nurse License: Possession of a valid… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks ... preparing reports regarding denials to include volumes, number of appeals , case resolution, and impact on revenue and trending....an accredited, professional nursing program. + Must have current RN license to practice in the state of Pennsylvania… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve ... experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred.… 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...conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate… more
- Independent Health (Buffalo, NY)
- …(RHIA), Registered Health Information Technician (RHIT), Certified Clinical Documentation Specialist (CCDS), American Health Information Management ... coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with… 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 ... (ie, Puerto Rico), or in the District of Columbia. Occupational Therapist ( Clinical Specialist ), GS-13 Grade Requirements: Experience: In addition to meeting… 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 ... in VHA must be proficient in written and spoken English. Physical Therapist ( Clinical Specialist ), GS-13 Grade Requirements: Experience: In addition to meeting… more
- Houston Methodist (Sugar Land, TX)
- …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... review, case management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of… more
- Independent Health (Buffalo, NY)
- …regulatory standards, clinical criteria, and member benefit contract. **Qualifications** + Registered Nurse ( RN ) with active, current, unrestricted NYS ... Trustworthy, Collaborative and Accountable. **Essential Accountabilities** + Thoroughly investigate clinical appeals and complaints/grievances utilizing appropriate internal… more
- CaroMont Health (Gastonia, NC)
- …denial activity and appeal results. Maintains the Status Change Database. Performs retrospective clinical reviews/ appeals as part of denial process. The UR ... duties as assigned. Qualifications: Bachelor's degree from an accredited college with a clinical background. BSN required. Current RN license to practice in NC… more