- St. Luke's University Health Network (Allentown, PA)
- …ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- Mayo Clinic (Rochester, MN)
- …Financial Management Association (HFMA) Certification Preferred. **Preferred Qualifications:** + Current Registered Nurse ( RN ) license in the United ... long, successful career with Mayo Clinic. **Benefits Highlights** + Medical : Multiple plan options. + Dental: Delta Dental or...clinical experience, with 5+ years in case management, utilization review , or clinical denials/ appeals . + 3+ years… more
- Centene Corporation (Columbia, SC)
- …State and NCQA requirements. + Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of ... **Position Purpose:** Act as the liaison for all statewide appeals , fair hearings, review organizations, and other...NCQA standards. + Maintain files and logs for all appeals + Coordinate with Medical Director(s) to… more
- TEKsystems (Annapolis, MD)
- …more of the following: clinical, case management, denials, or billing + Must be a Registered Nurse or Licensed Nurse Practitioner Knowledge & Skills: + ... review initial clinical denials, determine appropriate next steps, and lead appeals efforts by analyzing medical necessity, addressing authorization issues,… more
- Actalent (Olympia, WA)
- …management and care coordination. + Experience with EPIC software. + Utilization review and appeals handling capabilities. + Discharge planning and population ... \Actalent is hiring for RN Case Managers! Job Description This role in...for this temporary role may include the following: * Medical , dental & vision * Critical Illness, Accident, and… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …more **Description** We're seeking under the direction of the **Utilization Management Appeals Professional, Registered Nurse ** is responsible for managing ... **MINIMUM QUALIFICATIONS** : + License - Must have a valid, active unencumbered Registered Nurse license or temporary permit approved by the Georgia Licensing… more
- R1 RCM (Boise, ID)
- …conduct a comprehensive review of clinical denials and formulate appeals based on clinical documentation, evidence-based medical necessity criteria, ... identify targeted areas for additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position, the base pay… more
- Nuvance Health (Danbury, CT)
- …in nursing, health administration, or a related field preferred * Current licensure as a registered nurse ( RN ) * Minimum of 5 years of clinical experience ... leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical...medical necessity outreach, and feedback to the utilization review team on denial outcomes. * *Discharge Planning &… more
- Evolent (Montgomery, AL)
- …Stay for the culture. **What You'll Be Doing:** Job Description The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part ... of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of...work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators… more
- State of Colorado (Denver, CO)
- …(HP III RN ) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5002223) Apply Registered Nurse Health Compliance Inspector Home Care - ... Registered Nurse Health Compliance Inspector Home Care -...FAA00601 (HP III RN ) Salary $80,916.00 Annually Location Denver, CO Job Type Full Time… more