- Eastern Connecticut Health Network (Manchester, CT)
- …degree in an applicable field required + Must have a current license as a Registered Nurse in the State of Connecticut . + Professional certification in case ... one week of discharge or receipt of a notice of denial. Successfully appeals denials , when indicated. + Performs comprehensive assessments and re-assessments of… more
- MVP Health Care (Rochester, NY)
- …York** **Qualifications you'll bring:** + Current New York State Licensure as a Registered Nurse required. + Certification in Case Management required within 24 ... after hire. + At least 3 years of recent clinical and Case Management experience. Experience working in a...maintain cost-effectiveness and manage Medical Loss Ratio (MLR). + Appeals & Denials : Participate in the … more
- CaroMont Health (Gastonia, NC)
- …Care Management and Senior management as necessary. Retrospectively reviews medical record for clinical denials . Composes a detailed summary of care and sends ... activity and appeal results. Maintains the Status Change Database. Performs retrospective clinical reviews/ appeals as part of denial process. The UR Specialist… more
- Guthrie (Binghamton, NY)
- …needed for patient that have arrived without orders. Prepare educational materials for the RN Nurse Navigator for Chemo Education Visits per the instruction and ... of coverage of ordered medications. + Coordinate and complete appeals for denials as needed + Monitor...offices and for DBL office as needed Coverage for RN Nurse Navigator + Coordinate and facilitate… more
- Guthrie (Corning, NY)
- …needed for patient that have arrived without orders. Prepare educational materials for the RN Nurse Navigator for Chemo Education Visits per the instruction and ... of coverage of ordered medications. * *Coordinate and complete appeals for denials as needed * *Monitor...offices and for DBL office as needed Coverage for RN Nurse Navigator * *Coordinate and facilitate… more
- BriteLife Recovery (Englewood, NJ)
- …and continued stay authorizations from insurance payers by effectively communicating clinical information and advocating for appropriate levels of care. The UR ... Specialist works closely with clinical staff, admissions, medical providers, and third-party payers to support patient access to treatment and maintain financial… more