- UnityPoint Health (Cedar Rapids, IA)
- …of health care resources, provision of high-quality health care, optimal clinical outcomes and patient and provider satisfaction. The UM Specialist provides ... UM spcialist will also be called upon to provide clinical and nursing expertise and support within the HOD...party payers regarding authorization of stay, continued stay reviews, appeals and denial letters. + Provides education and serves… more
- Community Health Systems (Franklin, TN)
- …Knowledge of HIPAA regulations and patient confidentiality standards. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or ... **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating...conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate… more
- CVS Health (Charleston, WV)
- …licensure in non-compact states as needed. + 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of ... Managers, Manager, and other key stakeholders such as Medical Directors, account teams/ clinical liaisons, etc.) to ensure consistency in clinical interventions… more
- Monte Nido (Miami, FL)
- …in level of care, discharge, retrospective, facilitating peer to peer reviews, and written appeals . + Engage in clinical rounds as an active treatment team ... team approach while integrating state-of-the-art medical, psychiatric, nutritional, and clinical strategies to provide comprehensive care within an intimate home… more
- UHS (Binghamton, NY)
- …(5) years of experience in acute/tertiary facility. + Minimum Required: NYS Licensed Registered Nurse Preferred: + Bachelor's of Science in Nursing with three ... Position OverviewUnited Health Services (UHS) is seeking a proactive and analytical Clinical Denials Specialist to join our Revenue Cycle team. In this vital role,… more
- Guthrie (Binghamton, NY)
- …to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals . Assesses and coordinates discharge planning needs with ... Gastroenterology and Pulmonary Critical Care Fellowship programs. Guthrie is also a clinical campus for the Geisinger Commonwealth School of Medicine. more
- Beth Israel Lahey Health (Plymouth, MA)
- …and determines appropriate strategy in response to reimbursement denials. + Responsible for appeals and follow up on clinical denials escalated through a work ... queue, providing appropriate response supported by clinical information. + Provides oversight of the appeals process and direction regarding appeals and… more
- State of Colorado (Sterling, CO)
- …Rights MINIMUM QUALIFICATIONS: + Applicant must possess a current, valid license as a Registered Nurse from the Colorado Board of Nursing or any state ... III 30492 09/2025 Department Department of Corrections Division Clinical and Correctional Services Opening Date 09/09/2025 Closing Date...years of full-time experience providing patient care as a Registered Nurse . W ork experience less than… more
- State of Colorado (Garfield County, CO)
- …night shifts to include holiday & weekends as needed? + Must possess a valid Registered Nurse License ( RN ) from the Colorado Department of Regulatory ... of Employment & Appeal Rights Education/Licensure/Certification/Experience: Current, valid licensure as a Registered Nurse from the Colorado Board of Nursing or… 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… more