- Molina Healthcare (Warren, MI)
- …hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical … more
- Memorial Sloan-Kettering Cancer Center (New York, NY)
- …appeals and acquire authorizations for treatment **Key Qualifications:** + Current NYS Registered Nurse License/Registration and BSN preferred + At least 2-3 ... Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of… more
- CommonSpirit Health Mountain Region (Westminster, CO)
- … Clinical Career Ladder to help you grow and recognize your contributions to clinical excellence! As a Nurse with us you will assume responsibility and ... external applicants with at least six months of direct RN experience are eligible for a $20,000 sign-on bonus!**...care for orthopedic, abdominal, and general surgeries. 5 West appeals to anyone interested in broadening their skillset as… more
- City and County of San Francisco (San Francisco, CA)
- …Registered Nurse ( RN ) license issued by the California Board of Registered Nursing; AND + Clinical Nurse Specialist Certificate: Possession of a ... assists with designing and implementing plans for meeting such needs. The Clinical Nurse Specialist performs other related duties as assigned/required. Minimum… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …18 month commitment before posting for other internal positions\. **Job Qualifications** _License_ + Registered Nurse \( RN \) with active license in the state ... retrospective claim review, special review requests, and UM pre\-certifications and appeals , utilizing medical appropriateness criteria, clinical judgement, and… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- … clinical committees. Essential Qualifications + Active and unrestricted license as a Registered Nurse ( RN ). + Bachelor's degree in nursing, (or ... manage the Utilization Management team consisting of Clinicians and Non- Clinical support staff from Intake through Appeals ...and Non- Clinical support staff from Intake through Appeals processing. The ideal candidate will have a strong… more
- State of Colorado (Denver, CO)
- …NA 01 A requirement of the position is that you possess and maintain a VALID Registered Nurse ( RN ) License issued by the State of Colorado or any ... Rights Minimum Qualifications: Education/Licensure/Certification/Experience: Current, valid licensure as a Registered Nurse from the Colorado Board of Nursing… more
- Tufts Medicine (Melrose, MA)
- …providing clinical updates to insurance companies. 11. Coordinates insurance appeals related to discharges and adhering to policies and procedures of Medicare ... to home with a community hospital. **Job Overview** The RN Case Manager manages a designated caseload to coordinate...scores which meet or exceed hospital established targets for nurse sensitive quality indicators as appropriate for the unit.… more
- Amergis (French Camp, CA)
- …multidisciplinary teams Knowledge of current Medicare guidelines Clinical critical thinking Clinical experience x 2 years Denials nurse : We need someone that ... $3,042.00 **Local Pay $75/hr** - No stipend pay The RN Case Manager is responsible for coordinatingcontinuum of care...is current with Denials, Appeals and utilization review . If a candidate had… more
- Bassett Healthcare (Cooperstown, NY)
- …in a healthcare setting, preferred Licensure/Certifications: + Current NYS licensure as a Registered Professional Nurse , if applying as a nurse , required ... of life possible. What you'll do The Case Manager RN supports the physician and interdisciplinary team in facilitating...with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost… more