- Excellus BlueCross BlueShield (Buffalo, NY)
- …peer-to-peer calls in timely manner and provides support for the Case Management (CM) and Registered Nurse ( RN ) reviewers and manages the denial process. + ... Administration of BH QM/UM and performance improvement activities, including grievances and appeals . + Attendance at regular (at least quarterly) Plan leadership and… more
- State of Colorado (Pueblo, CO)
- …Reports ALL claims of harassment/workplace violence, alerts public safety/charge RN / Nurse Manager/and nursing appointing authority immediately Communication/ ... + Reports ALL abuse allegations immediately to the charge RN / Nurse Manager/nursing appointing authority and refer to...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Denver, CO)
- …experience working in a pediatric or family medicine clinical setting as a registered nurse or a medical practice manager, knowledge of clinical protocols ... MINIMUM QUALIFICATIONS: Experience Only: Six (6) years of professional experience as a RN , public health nurse , community health nurse , healthcare clinic… more
- Mount Sinai Health System (Long Island City, NY)
- …field. **Licensing and Certification Requirements (if applicable)** Licensed as a registered nurse , Issuing Agency: Department of Health/Office of Professions ... will direct and manage departmental activities involved in utilization review, appeals management and discharge planning to facilitate the case management process… more
- Hartford HealthCare (Farmington, CT)
- …of education and experience in accordance with job responsibilities *Experience* . Minimum: . Registered Nurse ( RN ) with 5 or more years CDS experience ... (HACs), and other specialty reviews. This position also supports denials and appeals specialists as a subject matter expert (SME) and collaborates with Revenue… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate efficient… more
- Catholic Health Services (West Islip, NY)
- …(BSN) 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
- CareFirst (Baltimore, MD)
- …+ Proficient in Microsoft Office programs. **Licenses/Certifications Required Upon Hire** : Health Services\ RN - Registered Nurse - State Licensure and/or ... authorization of services and approved claims. + Prepares retrospective reviews, case appeals , billing coordination, and clinical support. + Manages the analysis of… 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 ... agencies, to coordinate activities involved in medical record review, denials, appeals and reconsideration hearings. Works closely with the physician advisor to… more
- San Antonio Behavioral Health (San Antonio, TX)
- …May consult with staff as needed. Essential Duties: + Collaborate and set standards with registered nurse ( RN ) case managers (CMs) and outcome managers to ... of potential denials and respond appropriately; ie facilitate Physician to Physician appeals when appropriate and assist with construction of appeal letters. +… more