- Children's Mercy Kansas City (Kansas City, MO)
- …1-2 years experience + Experience in Utilization Review + One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon ... leadership to integrated inpatient teams; assists Director in the management of department; including personnel and fiscal management...hire + One of the following: Licensed RN - Kansas, Registered Nurse … more
- Houston Methodist (The Woodlands, TX)
- …the Case Manager PRN (CM) position is a licensed registered nurse ( RN ) who comprehensively plans for case management of a target patient population on a ... resource utilization, and continued stay. Reviews level of care denials to identify trends and collaborate with team to... management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- Houston Methodist (The Woodlands, TX)
- …the Case Manager (CM) Certified position is a registered nurse ( RN ) responsible for comprehensively planning for case management of a targeted patient ... resource utilization, and continued stay. Reviews level of care denials to identify trends and collaborate with team to... management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- BronxCare Health System (Bronx, NY)
- …response by the department physician advisors and clinical staff. Qualifications - NYS Registered Nurse required - The Appeal Manager must have excellent verbal ... department's leadership develop strategies for denial prevention, improved utilization management , documentation of medical necessity and identify patterns and… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued stay reviews, supports… more
- Rochester Regional Health (Rochester, NY)
- …Support - American Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education ... Job Title: Care Facilitator Department: Case Management Location: Canton-Potsdam Hospital with floating to other...required + Licensed in New York State as a Registered Nurse + For hires after 10/28/2024,… more
- BronxCare Health System (Bronx, NY)
- …special projects and committees as determined by Director. Qualifications CERTIFICATION/LICENSURE : Registered Nurse or physician or a foreign medical graduate ... Overview Assists in the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care… more
- Covenant Health Inc. (Knoxville, TN)
- …reviews to assign initial DRGs and GMLOS for physicians and case management to follow. + Collaborates extensively with individual physicians and other medical ... to coding. + Monitors activities and findings with regard to audits and denials and subsequently adjusts to potential trends when reported. + Attends meetings and… more
- Rochester Regional Health (Rochester, NY)
- …experience preferred. + Experience with EPIC preferred. EDUCATION: BS LICENSES / CERTIFICATIONS: RN - Registered Nurse - New York State Education ... and performance standards. + Provides direct managerial oversight to CDI Team in management of CDI processes CDI projects, barriers and education work processes, to… more
- Montrose Memorial Hospital (Montrose, CO)
- …business letter writing, eg, appeals, preferred. + Must at least be Licensed as a Registered Nurse in the State of Colorado or possess a Compact State License. ... Denial Analyst is considered a clinical expert in Denial Management and ensures all medical necessity denials ...Denial Management and ensures all medical necessity denials are accurately worked from a clinical perspective and… more