- Rochester Regional Health (Rochester, NY)
- …hospital and payors, ensuring accurate communication of clinical information, supporting appeals , and optimizing benefit use. + Collaborates with care teams to ... + Diploma from an accredited nursing school program or Associate 's Degree + 3 years acute hospital care experience...+ Licensed in New York State as a Registered Nurse PREFERRED QUALIFICATIONS: + Case Management or Utilization Management… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate , you are joining a culture that is built on values of succeeding ... * Identifies opportunities for connecting members to group related benefits; eg Nurse Line, Employee Assistance Program, or other specialists with in BCBS Health… more
- Alameda Health System (San Leandro, CA)
- …other documentation; contacts with payers conducting phone reviews and initiates denial appeals as needed. + Encourages patients to develop realistic plans. Makes ... according to Department standards. Keeps required statistics. **QUALIFICATIONS** Education: Associate 's degree in a related field. Bachelor's Degree preferred.… more
- CareFirst (Baltimore, MD)
- …authorization of services and approved claims. + Prepares retrospective reviews, case appeals , billing coordination, and clinical support. + Manages the analysis of ... programs. **Licenses/Certifications Required Upon Hire** : Health Services\RN - Registered Nurse - State Licensure and/or Compact State Licensure. Salary Range:… more
- Humana (Springfield, IL)
- …gaps in care and access. + Assists enrollees with filing grievances and appeals . + Provides information to enrollee related to MCO requirements, services, and ... a related field. + An active, unrestricted Licensed Practical Nurse (LPN) in the state of Illinois with one...on business needs. + **Language Assessment Statement:** Any Humana associate who speaks with a member in a language… more
- BrightSpring Health Services (Lexington, KY)
- …issues. Refer all unresolved issues to the next level including grievance and appeals . + Actively market plan to new senior care partners within plan Service ... Other special projects and duties, as assigned. Qualifications + Two-year associate /technical degree, bachelor's degree or experience with direct sales and… more
- McLaren Health Care (Grand Blanc, MI)
- …metrics, and key performance indicators (KPIs). **Qualifications:** **_Required:_** + Associate 's degree in nursing or healthcare related field **.** Current ... Registered Nurse license in the state of Michigan or possess...years of utilization management, case management, clinical documentation, and/or denials/ appeals experience in an acute healthcare facility** **.** American… more
- Community Health Systems (Franklin, TN)
- …role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate efficient ... duties as assigned. + Complies with all policies and standards. **Qualifications** + Associate Degree in Nursing required + Bachelor's Degree in Nursing preferred +… more
- Brockton Hospital (Brockton, MA)
- …agencies, to coordinate activities involved in medical record review, denials, appeals and reconsideration hearings. Works closely with the physician advisor to ... RN with Master's Degree + Current License as Registered Nurse in the Commonwealth of Massachusetts EXPOSURE CATEGORY: It...in the course of his/her regularly scheduled activities as associate of SHC Brockton Hospital and Signature Medical Group… more