- Alameda Health System (San Leandro, CA)
- …AHA-American Heart Association. Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California. **PAY RANGE** ... SLH Case Manager RN + San Leandro, CA + San Leandro...contacts with payers conducting phone reviews and initiates denial appeals as needed. + Encourages patients to develop realistic… more
- Catholic Health Services (West Islip, NY)
- …degree required. + Master of Science degree strongly preferred. + Licensure: New York Registered Nurse ( RN ) License & Registration. + Certification: Care ... not limited to, Medical Staff, Quality/Risk Management, CH Utilization and Central Appeals , Managed Care and Revenue Cycle and Patient Access departments to ensure… more
- Whidbey General Hospital (Coupeville, WA)
- …LOS, cost per case, avoidable days, resource utilization, readmission rates, concurrent denials , and appeals . + Supports the vision, mission, and values ... JOB SUMMARY Are you a flexible, self-motivated RN who thrives in a collaborative, fast-paced environment?...Manager will lead an assessment to identify the patient's clinical needs to be accommodated and constructs a care… more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …appeals and acquire authorizations for treatment **Key Qualifications:** + Current NYS Registered Nurse License/Registration and BSN preferred + At least 2-3 ... The MSK Case Management Department is made up of Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and support...you will be responsible for evaluating and responding to clinical and administrative denials referred to Case… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …experience is preferred. + **Certification/Licensure/Registration:** + Licensed as a Registered Nurse in the Commonwealth of Massachusetts preferred. ... high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and… more
- Amergis (French Camp, CA)
- …Case Manager Experience in ACUTE setting** Current Discharge Planning experience Denials experience + Appeals Experience Utilization review experience InterQual ... Working with multidisciplinary teams Knowledge of current Medicare guidelines Clinical critical thinking Clinical experience x 2...experience x 2 years Experience with PERFORMANT or CDCR denials PREFERRED not REQUIRED. The RN 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...This role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with… more
- Independent Health (Buffalo, NY)
- …American Health Information Management Association (CCS-H, CCS-P), Certification Denials and Appeals Management (C-DAM), or NYS licensed RN or LPN required. ... coding guidelines and financial policies/contracts. + Responsible for all reconsideration clinical appeals to include review of records, consultation with… 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...advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials , input into appeals , share findings with… more
- Brockton Hospital (Brockton, MA)
- …responsibilities. EDUCATION: + RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It is ... external review agencies, to coordinate activities involved in medical record review, denials , appeals and reconsideration hearings. Works closely with the… more